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Addressing the family planning needs of HIV/AIDS clients is a challenging issue. Programs and research in this area have begun to explore ways to address these needs, but much remains to be done.
Online Discussion Forum - Register to participate.
From March 5 to March 16, 2007, a two week-long online forum on client-provider interaction in FP/HIV integration will take place within the Implementing Best Practices (IBP) Knowledge Gateway. Everyone is welcome to participate, and membership in the Gateway is free. The discussion will be moderated by content experts from multiple organizations. The purpose of this event is to facilitate ongoing networking and dialogue among program managers, researchers, and others interested in improving CPI as it relates to clients’ FP needs within HIV/AIDS service settings. Better counseling on FP for HIV/AIDS clients can enhance client satisfaction and improve health outcomes. This year’s event will focus on clients’ experiences and perspectives.
You can view the archived Webcast of the videoconference session on the same topic that took place on March 1, 2007. The videoconference connected participants at sites in Baltimore, Geneva, Atlanta, Addis Ababa, and Johannesburg and included representatives from Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and highlighted Pathfinder International’s experiences in Ethiopia, and Family Health International’s (FHI) work in South Africa. Sponsors included the Health Communication Partnership (HCP) and the INFO Project, both based at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs, in conjunction with the partners from the Implementing Best Practices Initiative including the World Health Organization Department of Reproductive Health and Research (WHO/RHR), and USAID.
Resources
Videoconference Presentations
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Contraceptive Needs and Preferences of PMTCT Clients in South Africa
Dr. Jennifer Moodley, Women's Health Research Unit, Scool of Public Health and Family Medicine, University of Cape Town
Dr. Moodley presented the results of a collaborative study conducted by the Women’s Health Research Unit (WHRU) and Family Health International. The objectives of the study were to assess the contraceptive needs and preferences of clients in PMTCT clinics in South Africa and to evaluate the capacity of antenatal care, delivery services and child health services to meet the contraceptive needs of PMTCT clients. The study was also designed to assess the capacity of family planning services to meet the needs of HIV+ women and to identify ways to improve access to FP services by PMTCT clients. South Africa has a growing number of women who are pregnant and HIV positive. This study will also provide baseline information for designing future interventions aimed at facilitating the use of contraception by PMTCT clients. Dr. Moodley and her colleagues conducted structured observations in three types of clinics in both urban and rural areas of two provinces. They also plan to conduct focus group discussions with providers and a workshop with program managers. So far they have developed a demographic profile of clients and their partners. Most women involved in the study were between the ages of 16 and 40 and had 1 to 2 other children. They tended to be unemployed and married or in a stable monogamous relationship. Most had used family planning in the past and did not want to have another child. 90% said they would use contraception after delivery. Favored methods were the condom and the injectable. Dr. Moodley and her colleagues also asked questions about history of use of family planning, fears about safety of FP methods, interest in FP, exposure to counseling and service delivery preferences. They concluded that many of these women face a risk of repeat pregnancy. The women have misconceptions about the safety of some contraceptive methods. They have not received good counseling so far but expressed a desire to receive better counseling in the future.
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Integration Prevention, Counseling and Testing for HIV into Family Planning Services in South Africa
Dr. Saiqa Mullick, Population Council (Frontiers)
Dr. Saiga Mullick discussed the results of a study to integrate prevention, counseling, and testing for HIV into family planning services in South Africa. The objectives of this study were to evaluate two models of integration on feasibility, acceptability, cost and quality of family planning and develop and evaluate a “best’ model for effectiveness. In the “High level integration” model, FP providers were trained to routinely offer counseling and testing as well as to conduct testing if required. In the “Low level integration” model, FP providers trained to routinely offer counseling and testing but refer clients to vertical service for testing. This project was implemented in two phases at clinics which provide FP services, have a high volume of FP clients, have more than one professional nurse, conduct HIV testing, and provide STI treatment. In the first phase, feasibility, acceptability, quality of FP and cost were evaluated and client-provider interaction was observed and exit interviews were conducted pre and post intervention. In the second phase, the effectiveness of a “better” intervention model in increasing VCT and dual protection was compared to standard practice and evaluated. In both interventions, family planning services were standardized and strengthened through training providers in the “Balances Counseling Strategy” (BCS) approach to family planning. In this strategy, the client is given information and a choice on the narrowed down set of appropriate contraceptive methods. The information is also given to the client via pamphlets. Cards on STI/HIV risk and dual protection were also used during the session to ensure that STI risk information is provided during all consultations (“BCS plus”). In both the “high level” and “low level” models of integration, reproductive history taking increased, providers’ mention of condoms as well as instructions for how to use condoms increased, providers’ mention of dual protection and discussion of counseling and testing improved, clients’ reporting condom use at last sex, clients’ ever having had an HIV test and clients’ partner having had an HIV test improved. In the high level model, there was no significant change in discussion of contraceptive methods from pre to post intervention. More clients reported always use of condom after the implementation of the low level model; fewer clients reported always use of condom after the implementation of the high level model. Results indicate that integration of HIV prevention and the routine offer of testing in FP settings is feasible and does not negatively impact on quality of existing FP services. Dr. Mullick and colleagues are currently modifying the intervention to improve linkages with other services and to incorporate status specific care into FP services.
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Integration of RH/FP and HIV/AIDS Activities: Experience of Pathfinder International from Implementing Best Practices (IBP) and Other Initiatives
Dr. Mengistu Asnake, Pathfinder International
Dr. Asnake discussed three experiences of integrating family planning (FP) and HIV/AIDS services in Ethiopia. The goals of these activities include:
1) increasing access to FP information and services in VCT/PMTCT settings
2) expanding FP services to HIV positive couples in order to prevent unintended pregnancies and mother to child transmission of HIV
3) reducing stigma and discrimination at VCT/PMTCT sites; and
4) identifying, selecting, and promoting best practices in integration.
All activities are supported by the Implementing Best Practices (IBP) Initiative. The first activity took place at 64 individual facilities (hospitals and health centers) in four regions of Ethiopia. The second took place at the community level; all CBRHAs took part in a refresher training in order to provide information on FP and HIV/AIDS to clients, provide condoms and pills, and refer clients to other FP methods as well as VCT and STI treatment. The third was designed to integrate FP into an existing HIV/AIDS care and support program. After these activities were implemented, a significant reduction in stigma and discrimination was observed. Dr. Asnake and colleagues note that challenges include high turnovers of trained providers at facility levels, seasonally high workloads and provider burnout, limited choices of FP methods at VCT sites, and little emphasis on FP counseling within HIV counseling trainings. Future plans include scaling up integration at more facilities, operational research on the process and outcomes of integration, and sharing experiences with other researchers.
Presenter Biographies
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Dr Jennifer Moodley is a senior public health physician at the Department of Health, Provincial Government of the Western Cape and the Director of the Women’s Health Research Unit at the School of Public Health and Family Medicine, University of Cape Town. She is involved in research, undergraduate and postgraduate teaching and has worked as a clinician in both urban and rural settings in South Africa. Dr Moodley has extensive experience in health systems research. She is one of the Principal Investigators in a study that is assessing the contraceptive needs of PMTCT clients in South Africa. The aim of this study is to provide baseline information for the design of an intervention aimed at facilitating contraceptive use among PMTCT clients. Dr Moodley is a co-investigator in a study looking at the reproductive choices of HIV positive women and men in Cape Town. The overall aim of this project is to inform the improvement of reproductive health service delivery among HIV-infected women and men by providing insights into the attitudes, beliefs and opinions of HIV-infected individuals and of health service providers. Dr Moodley has been involved in research that developed, tested and evaluated health system interventions for improving cervical screening services in South Africa.
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Dr. Mengistu Asnake is a public health specialist with 20 years of experience in Primary Health Care, child survival, community health services, program management, training and clinical service delivery. In the current position, he is actively involved in developing, monitoring, evaluating FP/RH projects and coordinating technical and programmatic activities of Pathfinder in Ethiopia. Working at different levels of MOH, he was involved in program management, training, IEC, supervision and coordinating activities with donors, governmental agencies and NGOs. As a clinical medical officer in ALERT, he was involved in the training of international trainees in the area of Leprosy and Tuberculosis and several operational researches. In addition, He was primarily involved in the initiation of the first combined Tuberculosis and leprosy program in Ethiopia in a pilot area in Southern Region using the DOTS strategy in 1994. During the same period he was involved in the development of a National Guideline for Tuberculosis and Leprosy which uses DOTS as a major strategy of treatment. As a Preventive and Promotive Health coordinator in the southern region with BASICS/ESHE/USAID project, he was primarily involved in child survival activities including working as a focal person in the introduction of Integrated Management of Childhood Illnesses (IMCI) in three pilot woredas. He also played an advisory role for the Health Bureau in Southern Region, during the initial development of different system strengthening activities that include HMIS. He worked as an advisor for the different operational researches supported by BASICS project. He also played an advisory role for the Regional Health Bureaus and the Federal Ministry of Health on different Public Health Issues. Currently as a voluntary contribution he is working as the President of the Ethiopian Public Health Association (EPHA) and executive board member of the World federation of Public Health Association (WFPHA).
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