***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To evaluate costs , cost-efficiency and cost-effectiveness of integration of family planning into HIV services . Intervention : Integration of family planning services into HIV care and treatment clinics . Design : A cluster-r and omized trial . Setting : Twelve health facilities in Nyanza , Kenya were r and omized to integrate family planning into HIV care and treatment ; six health facilities were r and omized to ( nonintegrated ) st and ard-of-care with separately delivered family planning and HIV services .  Main outcome measures : We assessed costs , cost-efficiency ( cost per additional use of more effective family planning ) , and cost-effectiveness ( cost per pregnancy averted ) associated with the first year of integration of family planning into HIV care . More effective family planning methods included oral and injectable contraceptives , subdermal implants , intrauterine device , and female and male sterilization . Patients and participants : We collected cost data through interviews with study staff and review of financial records to determine costs of service integration . Results : Integration of services was associated with an average marginal cost of $ 841 per site and $ 48 per female patient . Average overall and marginal costs of integration were associated with personnel costs [ initial ( $ 1003 vs. $ 872 ) and refresher ( $ 498 vs. $ 330 ) training , mentoring ( $ 1175 vs. $ 902 ) and supervision ( $ 1694 vs. $ 1636 ) ] , with fewer re sources required for other fixed ( $ 18 vs. $ 0 ) and recurring expenses ( $ 471 vs. $ 287 ) . Integration was associated with a marginal cost of $ 65 for each additional use of more effective family planning and $ 1368 for each pregnancy averted . Conclusion : Integration of family planning and HIV services is feasible , inexpensive to implement , and cost-efficient in the Kenyan setting , and thus supports current Kenyan integration policy Objective : To determine whether integrating family planning services into HIV care is associated with increased use of more effective contraceptive methods ( sterilization , intrauterine device , implant , injectable or oral contraceptives ) . Design : Cluster-r and omized trial . Setting : Eighteen public HIV clinics in Nyanza Province , Kenya . Participants : Women aged 18–45 years receiving care at participating HIV clinics ; 5682 clinical encounters from baseline period ( December 2009–February 2010 ) and 12 531 encounters from end-line period ( July 2011–September 2011 , 1 year after site training ) . Intervention : Twelve sites were r and omized to integrate family planning services into the HIV clinic  , whereas six clinics were controls where clients desiring contraception were referred to family planning clinics at the same facility . Main outcome measures : Increase in use of more effective contraceptive methods between baseline and end-line periods . Pregnancy rates during the follow-up year ( October 2010–September 2011 ) were also compared . Results : Women seen at integrated sites were significantly more likely to use more effective contraceptive methods at the end of the study [ increased from 16.7 to 36.6 % at integrated sites , compared to increase from 21.1 to 29.8 % at controls ; odds ratio ( OR ) 1.81 , 95 % confidence interval ( CI ) 1.24–2.63 ] . Condom use decreased non-significantly at intervention sites compared to controls ( OR 0.64 , 95 % CI 0.35–1.19 ) . No difference was observed in incident pregnancy in the first year after integration comparing intervention to control sites ( incidence rate ratio 0.90 ; 95 % CI 0.68–1.20 ) . Conclusions : Integration of family planning services into HIV care clinics increased use of more effective contraceptive methods with a non-significant reduction in condom use . Although no significant reduction in pregnancy incidence was observed during the study , 1 year may be too short a period of observation for this outcome Background Increased fertility rates in HIV-infected women receiving antiretroviral therapy ( ART )  have been attributed to improved immunological function ; it is unknown to what extent the rise in pregnancy rates is due to unintended pregnancies . Methods Non-pregnant women ages 18–35 from four public-sector ART clinics in Johannesburg , South Africa , were enrolled into a prospect i ve cohort and followed from August 2009–March 2011 . Fertility intentions , contraception and pregnancy status were measured longitudinally at participants ' routine ART clinic visits . Findings Of the 850 women enrolled , 822 ( 97 % ) had at least one follow-up visit and contributed 745.2 person-years ( PY ) at-risk for incident pregnancy . Overall , 170 pregnancies were detected in 161 women ( incidence rate [ IR ] : 21.6/100 PY [ 95 % confidence interval ( CI ) : 18.5–25.2 ] ) . Of the 170 pregnancies , 105 ( 62 % ) were unplanned . Unmet need for contraception was 50 % higher in women initiating ART in the past year as compared to women on ART>1 year ( prevalence ratio 1.5 [ 95 % CI : 1.1–2.0 ] ) ; by two years post-ART initiation , nearly one quarter of women had at least one unplanned pregnancy . Cumulative incidence of pregnancy was equally high among recent ART initiators and ART experienced participants : 23.9 % [ 95 % CI : 16.4–34.1 ] , 15.9 % [ 12.0–20.8 ] , and 21.0 % [ 16.8–26.1 ] for women on ART 0–1 yr , > 1 yr–2 yrs , and > 2 yrs respectively ( log-rank , p = 0.54 ) . Eight hormonal contraceptive failures were detected [ IR : 4.4 [ 95 % CI : 2.2–8.9 ] , 7/8 among women using injectable methods . Overall 47 % ( 80/170 ) of pregnancies were not carried to term . Conclusions Rates of unintended pregnancies among women on ART are high , including women recently initiating ART with lower CD4 counts and higher viral loads . A substantial burden of pregnancy loss was observed . Integration of contraceptive services and counselling into ART care is necessary to reduce maternal and child health risks related to mistimed and unwanted pregnancies . Further research into injectable contraceptive failures on ART is warranted Background : Safer conception strategies may be used by people living with HIV to reduce HIV transmission to partners result ing from condomless sex for conception . The extent to which people living with HIV receive safer conception messages and use risk reduction strategies is largely unknown . Methods : We use prospect i ve data from a clinic-based cohort study in Johannesburg , South Africa . Women living with HIV ( WLWH ) aged 18–35 on antiretroviral therapy ( n = 831 ) completed a baseline survey and ≥1 follow-up visits assessing fertility intentions and pregnancy incidence ; an endline survey was administered 1 year postenrollment . Multivariate negative binomial regression models examined differences in the number of condomless sex acts by fertility intentions . Chi-squared statistics compared receipt of safer conception messages by fertility intentions and indicators of safer conception method use by partner HIV status . Results : The median baseline age of participants was 30.4 years and 25.3 % were in serodiscordant partnerships . WLWH trying to conceive were over 3 times more likely to have condomless sex compared with those not trying to conceive ( adjusted incidence rate ratio : 3.17 , 95 % confidence interval : 1.95 to 5.16 ) . Receipt of specific safer conception messages was low , although women with positive fertility intentions were more likely to have received any fertility-related advice compared with those with unplanned pregnancies ( 76.3 % vs. 49.1 % , P < 0.001 ) . Among WLWH trying to conceive ( n = 111 ) , use of timed unprotected intercourse was infrequent ( 17.1 % ) and lower in serodiscordant vs. concordant partnerships ( 8.5 % vs. 26.9 % , P = 0.010 ) . Conclusions : These findings suggest that clinic and patient-level interventions are needed to ensure that WLWH receive and use  safer conception strategies Little information exists on the impact of integrating family planning ( FP ) services into HIV care and treatment on patients ’ familiarity with and attitudes toward FP . We conducted a cluster-r and omized trial in 18 public HIV clinics with 12 r and omized to integrated FP and HIV services and 6 to the st and ard referral-based system where patients are referred to an FP clinic . Serial cross-sectional surveys were done before ( n = 488 women , 486 men ) and after ( n = 479 women , 481 men ) the intervention to compare changes in familiarity with FP methods and attitudes toward FP between integrated and nonintegrated ( NI ) sites . We created an FP familiarity score based on the number of more effective FP methods patients could identify ( score range : 0–6 ) . Generalized estimating equations were used to control for clustering within sites . An increase in mean familiarity score between baseline ( mean = 5.16 ) and post-intervention ( mean = 5.46 ) occurred with an overall mean change of 0.26 ( 95 % confidence intervals [ CI ] = 0.09 , 0.45 ; p = 0.003 ) across all sites . At end line , there was no difference in increase of mean FP familiarity scores at intervention versus control sites ( mean = 5.41 vs. 5.49 , p = 0.94 ) . We observed a relative decrease in the proportion of males agreeing that FP was “ women ’s business ” at integrated sites ( baseline 42 % to end line 30 % ; reduction of 12 % ) compared to males at NI sites ( baseline 35 % to end line 42 % ; increase of 7 % ; adjusted odds ration [ aOR ] = 0.43 ; 95 % CI = 0.22 , 0.85 ) . Following FP – HIV integration , familiarity with FP methods increased but did not differ by study arm . Integration was associated with a decrease in negative attitudes toward FP among men 
    Output:
    
Overall , integration was associated with higher modern method contraceptive prevalence and knowledge , although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy .
However , improving access to FP services through integration was not always sufficient to increase the use of more effective ( noncondom ) modern methods among women who wanted to prevent pregnancy .