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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Integrating Pregnancy Prevention Into an HIV Counseling and Testing Program in Pediatric Primary Care

TitleIntegrating Pregnancy Prevention Into an HIV Counseling and Testing Program in Pediatric Primary Care
Publication TypeJournal Article
Year of Publication2018
AuthorsWheeler, NJ, Upadhya, KK, Tawe, MS, Tomaszewski, K, Arrington-Sanders, R, Marcell, AV
JournalJ Adolesc Health
Volume63
Pagination50-56
Date PublishedJul
ISBN Number1054-139x
Accession Number29655517
Keywordsadolescents, contraception, HIV, Pregnancy prevention, Rapid HIV testing, Reproductive life plan, Young adults
Abstract

PURPOSE: Certified health educator (CHE)-based HIV counseling and testing typically focus on HIV and sexually transmitted infection (STI) prevention only. A quality improvement initiative examined integrating assessment of reproductive life plans, counseling about pregnancy prevention, and contraception referral into a CHE-based HIV testing program. METHODS: Between February 2014 and January 2017, in one urban pediatric primary care clinic serving patients aged 0-25, CHEs assessed sexual history, HIV risk, short-term (i.e., the next 6-12 months) pregnancy desire, and current contraception method and satisfaction among patients aged 13-25 who had ever had vaginal sex, using a standardized questionnaire. Data were analyzed using a de-identified administrative dataset that also tracked referrals to initiate contraception and actual method initiation. RESULTS: Of 1,211 patients, most (96%) reported no short-term pregnancy or partner pregnancy desire. Use of less effective or no contraception, as well as method dissatisfaction, was common. A high proportion of female patients referred to new methods opted for more effective methods (62%) and initiated these methods (76%); a high proportion of male patients opted for receipt of condoms (67%). Patients reporting short-term pregnancy desire reported higher rates of previous pregnancy and STIs. CONCLUSIONS: Program findings highlight the potential benefit of integrating assessment for and counseling about pregnancy prevention in a CHE-based HIV testing program. This can more effectively address the needs of patients with concomitant risks of STI/HIV and unintended pregnancy, and link patients who do not desire pregnancy to more effective methods.