Contraception to Prevent Unplanned Pregnancies among Women with HIV


  1. Definition of the Prevention Area

    From an HIV prevention perspective, family planning (FP) is a strategy to prevent vertical transmission of HIV (mother-to-child transmission or MTCT). Reducing the number of unplanned pregnancies in HIV-positive women reduces the number of infants exposed to HIV. Helping women with HIV meet their own goals for family size and child spacing is one of four elements of the World Health Organization’s (WHO) 2002 strategic approach to prevent mother- to-child transmission (PMTCT) of HIV. In April 2012, the World Health Organization (WHO) released a programmatic update, "Use of ARVs for Treating Pregnant Women and Preventing HIV Infection in Infants." In the executive summary, the WHO said: "Now a new, third option (Option B+) proposes further evolution—not only providing the same triple ARV drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting but also continuing this therapy for all of these women for life."

    There are several key factors to consider when planning and implementing programs to meet the family planning needs of women living with HIV:

    • The program's social behavioral communication strategy should reinforce and complement approaches for meeting the family planning needs of women living with HIV, and should extend between community outreach activities and the messages given at the health facility.
    • Managers should discuss and plan which family planning commodities (modern, traditional, and hormonal) to provide; what training health providers will need; and the type of health information system needed to document programmatic challenges and successes.
    • Programs and providers should carefully consider evidence on specific interactions between or among drugs to ensure that both the contraceptive and HIV treatment drugs a woman is taking are safe and effective when taken together.
    • Programs and providers should stress the importance of using a condom for dual protection regardless of other methods of family planning that may be used. Condoms can prevent both an unplanned pregnancy and HIV transmission. Male and female condoms are effective at reducing the risk of HIV transmission among serodiscordant couples.
  2. Epidemiological Justification for the Prevention Area

    During the PEPFAR expansion period, USAID funded several modeling studies showing that reducing the number of unplanned pregnancies among women with HIV can be as effective in reducing infant HIV infections as giving antiretrovirals (ARVs) to HIV-positive pregnant women. It is estimated that each year, contraceptive use prevents an estimated 577,200 unplanned pregnancies among HIV-positive women in sub-Saharan Africa, thus averting an estimated 173,000 HIV-positive births. Although many countries are working to implement the new WHO Option B+ policies to prevent MTCT and provide HIV treatment for women, family planning is a critical component for meeting the needs of all HIV-positive women.

  3. Core Programmatic Components

    Contraception as an HIV prevention intervention is most cost-effective when implemented in settings with generalized HIV epidemics that disproportionately affect women of reproductive age. Given that most women do not know their HIV status, Ministries of Health and collaborating programs should make FP services available to all women, both to maximize their HIV-prevention impact and to help all women achieve their fertility goals.

    Women living with HIV should have access to high-quality information and services so they can make informed decisions about future pregnancies. This includes information about the effectiveness, side effects, and possible interactions of contraceptive drugs with ARVs; and about the advantages of dual protection, delivered as part of measures to prevent vertical transmission of HIV. Discussing pregnancy intentions and providing access to contraceptives is an important service in HIV care and treatment settings to help women achieve their fertility goals, and because certain ARVs have toxicities that can affect the fetus. Trained counselors who can provide comprehensive information that addresses the needs of HIV-positive women, including details about all available family planning methods, are critical to high-quality family planning programs.

    In 2014, WHO issued a guidance statement on hormonal contraceptive methods for women at high risk of HIV and living with HIV. In general, women with HIV, including those taking ARVs, can use almost all contraceptive methods safely and effectively. However, the guidance notes that special consideration may be need for women using some hormonal methods with certain regimens for antiretroviral therapy (ART), specifically those including efavirenz or nevirapine, and some protease inhibitors. It specifies recommendations for hormonal contraceptive use for women living with asymptomatic or mild HIV clinical disease, and for those living with severe or advanced HIV clinical disease. WHO retains its position that women at high risk of HIV who choose progestin-only injectable contraceptives should also use condoms and other HIV-preventive measures, and that such women should be informed that progestin-only injectable contraceptives may or may not increase their risk of HIV acquisition.

  4. Current Status of Implementation Experience

    Although integrated FP/HIV services are scaling up globally, a number of obstacles continue to impede this process. These include separate funding streams for FP and HIV programming; the vertical organization of health ministries and service facilities; and lack of evidence for the effectiveness of integrated service delivery models. A publication by the WHO, USAID, and FHI 360 provides program planners, implementers, and managers with strategic considerations for implementing or strengthening integrated FP/HIV services.

    The global health community has recently increased attention and investment aimed at expanding FP, and linking family planning and HIV services. Toolkits and case studies have continued to document best practices and technical considerations, as well as ongoing challenges. The Country Operational Plan guidance issued by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) urges country teams to consider co-locating FP and HIV services, particularly at the primary health care level. PEPFAR encourages the programs it supports to train health workers to deliver an enhanced package of maternal, newborn, and child health services, including FP, for women living with HIV.

UPDATED 8/2015

Impact of Integrated Family Planning and HIV Care Services on Contraceptive Use and Pregnancy Outcomes: A Retrospective Cohort Study

Kosgei, R. J., Lubano, K. M., Shen, C., et al. Journal of Acquired Immune Deficiency Syndromes (2011), Vol. 58 No. 5, pp. e121-126.

The United States Agency for International Development-Academic Model Providing Access to Healthcare (AMPATH) Partnership in Kenya assessed a pilot program intended to increase HIV-positive women’s use of family planning (FP) methods. The study measured differences between routine care (RC) and an integrated family planning services (IFP) model to determine the effect of additional FP services in HIV care on use of modern contraceptive methods and pregnancy rates. The AMPATH site was in a hospital in Eldoret, Kenya, where more than 17,000 adult patients were receiving HIV care. In RC, two groups of patients totaling 2,578 received FP services, including condom counseling and availability as a means to reduce HIV transmission. In IFP, 1,453 patients received RC in addition to FP services. It was found that in the IFP group that the incidence of new condom use increased, as did use of new FP methods including condoms; and the incidence of new FP use excluding condoms decreased. There was no statistical difference in the number of new pregnancies in the IFP group. Findings on the attributable risk of the incidence rate per 100-person-years of IFP and RC followed similar trends. The study demonstrates that an IFP model can be successful in HIV care sites.

A Randomized Controlled Trial to Promote Long-term Contraceptive Use Among HIV Serodiscordant and Concordant Positive Couples in Zambia

Stephenson, R., Vwalika, B., Greenberg, L., et al. Journal of Women’s Health (2011), Vol. 20 No. 4, pp. 567-574.

This intervention aimed to increase use of modern family planning (FP) methods among HIV serodiscordant and seroconcordant couples in Zambia. Study data came from a cohort of 1,502 couples recruited through couples voluntary counseling and testing clinics and enrolled in a randomized controlled trial. The study had four arms. The "methods" group viewed one video on modern contraceptives. The "motivational" group viewed a second video that demonstrated positive future-planning behaviors such as will preparation and pregnancy prevention. The third group watched both. The control group watched a video on other healthy behaviors. After the groups watched the videos, counselors answered questions. Couples were invited to initiate, add, or change their modern contraceptive method free of charge. At baseline, only 21.5 percent of couples reported use of a modern FP method. After the intervention, 1,407 couples chose a new method or continued their current method. The most popular methods among new users were injectables and oral contraceptive pills (OCPs); among the 324 couples who were already using a method at enrollment, OCPs were the most chosen method post-intervention. It was also found that when couples switched from one method to another, they most likely switched from OCPs to Norplant and injectables. The study increased uptake of modern FP methods to high-risk couples.

Benefits and Costs of Expanding Access to Family Planning Programs to Women Living with HIV

Halperin, D. T., Stover, J.,& Reynolds, H. W. AIDS (2009), Vol. 23 Supplement 1, pp. S123-S130.

Preventing unwanted pregnancies averts mother-to-child transmission (MTCT) of HIV. This study, funded by the U.S. Agency for International Development (USAID), modeled the effects of providing contraception to all women of reproductive age (WRA) and the cost-effectiveness of this strategy in 14 countries with the highest HIV prevalence among WRA. It also modeled the aggregate effect for 139 countries worldwide. The annual cost per infant infection avoided by offering antiretroviral (ARV) drugs to all women living with HIV was estimated to be U.S.$543 for the 14 high-prevalence countries ($609 was the estimated cost worldwide), whereas the cost of a birth averted, if all women who wanted contraceptives received them, was $61 ($63 worldwide). The authors said that it is critical for high-prevalence countries to promote and offer family planning as a cost-effective means of preventing MTCT. This article was one of 14 in the AIDS supplement devoted to family planning and women living with HIV.

Family Planning and HIV

Wilcher, R., Cates, W., & Gregson, S. (eds.). AIDS (2009), Vol. 23 Supplement 1, pp. S1-S130.

The article was the first of 14 in the AIDS 2009 supplement devoted to filling key gaps in the literature on family planning and women living with HIV. The authors provided an overview of the evidence and studies contained in the supplement, starting with a history of the programmatic relationship between family planning and HIV services. They explained that the two fields have supported integration of services for more than 15 years, but limited funding streams often made it challenging to fulfill this goal. New evidence and policy support to better integrate services has emerged, and has been followed by increased funding and programs. The supplement included articles devoted to behavioral, biomedical, and programmatic research. The authors expressed their hope that the supplement would further discussion, support, and actual implementation of joint family planning and HIV services.

Reproductive Intentions and Outcomes Among Women on Antiretroviral Therapy in Rural Uganda: A Prospective Cohort Study

Homsy, J., Bunnell, R., Moore, D., et al. PLoS ONE (2009) Vol. 4 No. 1, p. e4149.

In a cohort of rural Ugandan women receiving antiretroviral therapy (ART), sexual activity and incidence of pregnancy significantly increased during follow-up, yet more than 93 percent of the women repeatedly expressed not wanting or not planning to have more children. In addition, more than 86 percent of sexually active women not desiring children were not using any modern contraceptive method other than condoms after two years on ART. In conclusion, women on ART and their partners should be consistently counseled on the effects of ART in restoring fertility, and should regularly be offered free and comprehensive family planning services as part of their standard package of care.

Sexual and Reproductive Health and HIV Linkages: Evidence Review and Recommendations

World Health Organization, United Nations Population Fund, International Planned Parenthood Federation,  Joint United Nations Programme on HIV/AIDS, and University of California San Francisco  (2009).

This report reviewed 58 studies (including peer-reviewed research and documents on promising practices) describing linkages between sexual and reproductive health (SRH) and HIV services. Overall, findings indicated that integrated services improve behavioral, health, and social outcomes. The results were disaggregated by type of clinic (antenatal, HIV treatment, family planning, primary health care, sexually transmitted infection), and factors that facilitate or impede integration were identified. The contributing authors provided recommendations for policymakers, program managers, and research evaluators to guide the implementation of integrated SRH and HIV service delivery.

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

McCoy S.I., Buzdugan, R., Ralph, l.J., et al. PLOS ONE (August 2014), doi: 10.1371/journal.pone.0105320. eCollection 2014.

This study assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy (9–18 months prior to interview). Nearly 9,000 eligible women were randomly sampled from diverse catchment areas of 157 health facilities in Zimbabwe that offer services for prevention of mother-to-child transmission. Participants were asked about HIV status, whether the birth was intended, and contraceptive use to determine the frequency of unintended and mistimed pregnancy; frequency of unintended pregnancy and serostatus; and association between unintended and mistimed pregnancy and serostatus. Analysis showed links between unintended pregnancy and unmet need for contraception and contraceptive failure in this setting. Of the 35 percent who reported that their pregnancies were unintended or mistimed, about half reported unmet need and the other half contraceptive use/failure. Overall, 12 percent reported that they were HIV-positive; these women were significantly more likely than HIV-negative women to report unintended pregnancy . There was no association between self-reported HIV status and contraceptive use or  non-use among women with unintended births. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite their intention to prevent or delay pregnancy. This underscores that women in Zimbabwe need greater access to contraceptive methods, including long-acting reversible contraception, to help them meet their pregnancy intentions. 

The Contribution of Family Planning towards the Prevention of Vertical HIV Transmission in Uganda

Hladik, W., Stover, J., Esiru, G., et al. PLoS ONE (2009), (4)11: e7691.

The authors used data on fertility, HIV infection, family planning (FP) use, and mother-to-child-transmission (MTCT) of HIV to create projections on the pediatric HIV burden in Uganda. These mathematical estimates indicated that family planning use—by virtue of preventing pregnancies among women living with HIV—averted a greater proportion of pediatric HIV infections (19.7 percent) compared to antiretroviral therapy (ART) for preventing MTCT (8.1 percent). Furthermore, the study found that unwanted fertility is a significant contributor to pediatric HIV cases. These greater benefits of FP use would remain even if ART use reached 80 percent of HIV-positive pregnant women. The authors argued that FP should be integrated in  programs for prevention of mother-to-child transmission, HIV TS programs, and postnatal care for all women of reproductive age, regardless of HIV status.

Strengthening Family Planning in a Large-Scale PEPFAR-Supported HIV Program

FHI 360 (September 2012).

This case study discussed the Zambia Prevention, Care and Treatment Partnership (ZPCT II), a five-year project funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) that integrates family planning (FP) into HIV clinical services to prevent vertical HIV transmission and reduce unintended pregnancies. ZPCT II, implemented by FHI 360 and several partners, works with the Zambian Ministry of Health to strengthen HIV clinical and prevention services at more than 380 health facilities in six provinces. At most of these sites, FP counseling is a core element of counseling and testing, prevention of mother-to-child transmission, and antiretroviral therapy services. For these and other activities—including community mobilization, provider training, and monitoring and evaluation—FP content and messages are tightly woven into service delivery. The result has been a sharp increase in client access to and use of FP. For example, the number of counseling and testing clients referred for FP rose from 75 to more than 2,500 after ZPCT II was launched. While ZPCT II has helped many women and couples living with HIV meet their contraceptive needs, time and budget constraints limit the project's ability to offer more than basic FP counseling and support to clients. The case study concluded that ZPCT II will provide essential lessons learned on FP integration to other PEPFAR-funded HIV projects.

Hormonal Contraceptive Methods for Women at High Risk of HIV and Living with HIV

World Health Organization (2015).

This guidance from the World Health Organization (WHO), issued in 2015 comprises recommendations on the use of hormonal contraceptive methods by women at high risk of HIV and women living with HIV. It provides evidence-based recommendations on contraceptive use for providers, policymakers, and the scientific community. The guidance was produced from the 2014 Guideline Development Group (GDG) meeting convened by WHO to review and, when indicated, revise the guidance on Medical Eligibility Criteria (MEC) for Contraceptive Use set out in the Fourth Edition. The guidance includes recommendations for hormonal contraceptive use among women at high risk of HIV infection; women living with asymptomatic or mild HIV clinical disease (WHO Stages 1 or 2); women living with severe or advanced HIV clinical disease (WHO Stages 3 or 4); and women living with HIV who are on antiretroviral therapy. It also lays out background considerations and the methods used to develop the guidance. 

The Executive Summary, which includes a list of changes from the fourth edition, can be found at:

10 Essential Steps: How to Strengthen Family Planning and HIV Service Integration

Family Health International. (2010).

This one-page document outlines 10 steps to help develop and implement an integrated family planning and HIV program. The 10 steps are: 1) generate demand for integrated services, 2) organize services, 3) ensure commodity security, 4) train providers, 5) screen all clients from an unmet need for contraception, 6) foster dual protection and dual-method use, 7) challenge provider bias, 8) reinforce referral systems, 9) strengthen skills for supportive supervision, and 10) monitor and evaluate performance.

Integration of Family Planning into HIV Counseling and Testing, Prevention of Mother-to-Child Transmission, and Antiretroviral Therapy Services, Training Facilitator’s Guide

Pathfinder International. (2010).

Designed to train practicing HIV service providers in family planning (FP) counseling and service provision for FP/HIV integration, this resource includes a trainer's guide, participant's guide, presentations, and job aid. Participants trained with this manual will be able to implement FP counseling and services for HIV counseling and testing, preventing maternal-to-child transmission of HIV, and antiretroviral therapy.

Rapid Assessment Tool for Sexual & Reproductive Health Linkages: A Generic Guide

International Planned Parenthood Federation, United Nations Population Fund, World Health Organization, et al. (2009).

The purpose of this tool is to assess HIV and sexual and reproductive health linkages at the policy, systems, and service delivery levels. It may be used to identify gaps and, to guide the development of country-specific action plans for forging and strengthening these linkages.

HIV and Family Planning Integration in Tanzania, Building on the PEPFAR Platform to Advance Global Health

Fleischman, Janet. Center for Strategic & International Studies (July 2012).

The report described how Tanzania was able to integrate family planning and HIV services to improve the lives of women, girls, and ultimately, their families and communities. The U.S. President's Emergency Plan for AIDS Relief, the United States Agency for International Development's Office of Population and Reproductive Health, and other bilateral programs worked together to increase the access and availability of health services targeting women and adolescents. The author noted the successes and challenges of the program, and stated that the approach could be replicated and scaled up in other countries.

Update to CDC’s U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection or Infected with HIV

U.S. Centers for Disease Control and Prevention (June 2012).

These revised recommendations by the U.S. Centers for Disease Control and Prevention (CDC) affirm previous guidance stating that there is no definitive link between hormonal contraceptives and an increase of HIV infection among women, and that all women who use contraceptive methods other than condoms should be counseled on condom use and prevention of sexually transmitted infections. This report follows a thorough review by the CDC of recent studies examining this link. The CDC concludes, as does the World Health Organization, that women at of HIV infection or HIV-positive women can continue to use all hormonal contraceptive methods without restriction. This revision does include a clarification for women at high risk for HIV infection who use progestin-only injectables on the inconclusive nature of the evidence on the association between use of injectables and HIV acquisition. It also stresses the importance of condom use and other HIV prevention measures; outlines various contraceptive methods; and recommends the use of a contraceptive method mix.

Integrating Family Planning into HIV Programs: Evidence-Based Practices

U.S. Agency for International Development, FHI 360, and Preventive Technologies Agreement (2013).

This document summarizes and synthesizes the expanding evidence base for integration of family planning HIV services. It draws from research, program experience, and technical guidance to make recommendations for initiating and scaling up integrated services. It emphasizes practical steps to help program managers, policymakers, and funders advance this integration. The document outlines the compelling rationale for and impact of integrating the two services. Benefits of integration include program efficiency; considerations include helping clients who wish to delay, space, or limit pregnancies; and ensuring healthy pregnancies and deliveries among those who wish to have a child. The document also highlights key factors that may facilitate or hamper program and service integration, and provides a table summarizing different practical levels for providing contraceptive information, counseling, and methods at HIV service delivery points. It also includes an annotated list of key tools and resources to support integrated programming, and a comprehensive list of references. 

Family Planning and HIV Services Integration Toolkit

USAID, FHI 360, Johns Hopkins, Marie Stopes International (2015).

This toolkit, provided by K4Health, is aimed at diverse audiences including policymakers, program managers, service providers, and advocates. Through an interactive website, it provides information on the rationale for integrating family planning and HIV services, along with detailed resources for research, policy, training, service delivery, program management, communication and advocacy, and understanding country experiences. The tool compiles and organizes numerous substantive technical resources including specific technical training materials and guidelines, job aids, rapid assessment tools for services and facilities, materials for advocacy and communications, and guides for procurement, logistics, and decision making. A separate section includes considerations and technical issues related to serving young people; and country case studies provide reflections and lessons from program implementation experience. 

Implementation of Global Health Initiative: Consultation Document

Global Health Initiative and U.S. Agency for International Development (2012).

The Obama administration wishes to strengthen global health around the world. This 2012 document outlined goals for HIV and AIDS, malaria, tuberculosis, neglected tropical diseases, maternal and child health, family planning and reproductive health, and nutrition. The new model for the U.S. Government global health assistance program, which dedicated an unprecedented $63 billion over six years, began in 2010. One of its goals is to move from an emergency response to sustainable, country-owned efforts. An emphasis on women- and girls-centered services is a guiding principle. Other principles include increasing impact through strategic coordination and integration; strengthening and leveraging key multilateral organizations, global health partnerships, and private sector engagement; encouraging country ownership and investing in country-led plans; building sustainability through health systems strengthening; improving metrics, monitoring, and evaluation; and promoting research and innovation. 

Technical Brief: Hormonal Contraception and HIV

U.S. Agency for International Development, U.S. President's Emergency Plan for AIDS Relief, Department of Health and Human Services, and Centers for Disease Control and Prevention (USAID and PEPFAR September 2013).

This collaboratively developed brief summarizes current epidemiological evidence on the use of hormonal contraception (HC) and specific issues associated with HIV acquisition and transmission. It addresses several specific questions with respect to the risk of: HIV acquisition by women using HC; HIV transmission from women living with HIV who use HC to male partners; faster disease progression among women living with HIV who use HC; and any drug interactions between HC and antiretroviral therapy for women who are using both drugs. The brief is aimed at several key groups of decision makers working in HIV and AIDS and family planning: national policymakers, U.S. government program managers, and implementing partners. Drawing on available evidence, the brief summarizes both what is known and key unanswered questions and areas where the evidence is lacking or inconclusive. It recommends that national programs consider expanding access to HIV testing and counseling within family planning programs, using recently updated WHO guidelines to update national guidelines, and expanding the contraceptive method mix, including male and female condoms and messaging to reinforce dual method use. The brief also lays out what the evidence means for policymakers and providers serving HIV-negative women, and those serving HIV-positive women. Finally, it includes a list of resources and references. 

Technical Issue Brief: Drug Interactions Between Hormonal Contraceptive Methods and Anti-Retroviral Medications Used to Treat HIV

U.S. Agency for International Development, U.S. President's Emergency Plan for AIDS Relief, Department of Health and Human Services, and Centers for Disease Control and Prevention (2014). 

This collaboratively produced brief is aimed at key decision makers working in HIV and AIDS and family planning: national policymakers, U.S. government program managers, and implementing partners, practitioners, researchers and professional societies. It outlines the current state of knowledge about whether specific antiretrovirals (ARVs) interact with specific hormonal contraceptive methods, including any decreases in efficacy, or increased toxicities or side effects. This information is timely, since some ARVs that have raised concern about potential drug interactions are being used more widely. The brief describes the types of hormonal contraceptives, the types of ARVs, and commonly used antiretroviral regimens. It summarizes reasons for uncertainty around potential drug interactions and describes available evidence, including a table specifying what is known about the possible effects of specific ARVs on the efficacy of hormonal contraceptive methods. The brief outlines programmatic implications; identifies areas for further research; and refers readers to several additional resources.  

The Case for Integrating Family Planning and HIV/AIDS Services: Evidence, Policy Support, and Programmatic Experience

FHI 360 (2010).

Eight short policy briefs summarize the state of integration between the family planning and HIV. These briefs highlight developments in the integration of family planning and HIV, including changes in the policy environment, new programmatic examples, and findings from operations research. Some include links to additional key tools and resources.

Making the Case for Interventions Linking Sexual and Reproductive Health and HIV in Proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria

World Health Organization (2010).

This report offers a rationale for seven HIV program interventions that can make good programs better through a holistic approach to HIV. Among these interventions is "PMTCT-Plus," which includes integrating family planning into services to prevent mother-to-child transmission of HIV.

A Practical Guide to Integrating Reproductive Health and HIV/AIDS into Grant Proposals to the Global Fund

Hardee, K., Gay, J., and Dunn-Georgiou, E. (2009).

This document was developed to help countries and organizations integrate reproductive health, including family planning and HIV, in proposals submitted to the Global Fund for AIDS, Tuberculosis and Malaria. Grounded in the research, programmatic, and policy literature on linkages and integration, this document asks and answers the following questions: 1) What is integration? 2) Given a country's context, what policies and programs could be linked and integrated? 3) What are the integration implementation challenges to be aware of when writing a proposal? and 4) How can integration be monitored and evaluated? In addition to providing evidence that integration improves HIV and AIDS outcomes, it provides examples from country programs and the integration components of successful Round 8 proposals.

Strategic Considerations for Strengthening the Linkages between Family Planning and HIV/AIDS Policies, Programs, and Services

World Health Organization, U.S. Agency for International Development, and Family Health International (2009).

This document is designed to help program planners, implementers, and managers, including government officials and other country-level stakeholders, make appropriate decisions about whether to pursue the integration of family planning and HIV services. It also explains how to approach integration in a strategic and systematic manner to achieve maximum public health benefit. Links to resources that support implementation, such as facility assessment tools, training curricula, and job aids, are provided.