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

Noah J. Wheeler, Krishna Upadhya, Marie Sophie Tawe, Kathy Tomaszewski, Renata Arrington-Sanders, Arik V. Marcell

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalJournal of Adolescent Health
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Adolescents
  • Contraception
  • HIV
  • Pregnancy prevention
  • Rapid HIV testing
  • Reproductive life plan
  • Young adults

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health

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