Field Experiences Integrating Family Planning into Programs to Prevent Mother‐to‐Child Transmission of HIV

Horizons, Washington, DC, USA.
Studies in Family Planning (Impact Factor: 1.28). 10/2005; 36(3):235-45. DOI: 10.1111/j.1728-4465.2005.00064.x
Source: PubMed


This article reviews field experiences with provision of family planning services in prevention of mother-to-child transmission (PMTCT) programs in ten countries in Africa, Asia, and Latin America. Family planning is a standard component of most antenatal care and maternal-child health programs within which PMTCT programs are offered. Yet PMTCT sites often miss opportunities to provide HIV-positive clients with family planning counseling. Demand for family planning among HIV-positive women varies depending on the extent of communities' openness about HIV/AIDS, fertility norms, and knowledge of PMTCT programs. In Kenya and Zambia, no differences were observed in use of contraceptives between HIV-positive and HIV-negative women in the study communities, but HIV-positive women have more affirmative attitudes about condoms and use them significantly more frequently than do their HIV-negative counterparts. In the Dominican Republic, India, and Thailand, where HIV prevalence is low and sterilization rates are high, HIV-positive women are offered sterilization, which most women accept. This article draws out the policy implications of these findings and recommends that policies be based on respect for women's right to informed reproductive choice in the context of HIV/AIDS.

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    • "Very few women in our study had discussed contraception with a health care provider, although this may be due to the fact that the data used for this analysis was collected during enrolment, at which time women may only have attended their first ANC visit. It is highly likely that family planning and contraception would only be discussed at later visits, or post-partum [9], and we will explore this in analysis of our follow up data. However, the high percentage of women who reported their current pregnancies as unplanned seem to support the idea that access to contraception is still limited for HIV-positive women in Kenya, and the lack of discussion of family planning during ANC visits presents a missed opportunity. "
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    ABSTRACT: Background The prevention of mother-to-child transmission of human immunodeficiency virus (HIV) is lauded as one of the more successful HIV prevention measures. However, despite some gains in the prevention of mother-to-child transmission of HIV (PMTCT) in sub-Saharan Africa, mother-to-child transmission rates are still high. In Kenya, mother-to-child transmission is considered one of the greatest health challenges and scaling up PMTCT services is crucial to its elimination by 2015. However, guideline implementation faces barriers that challenge scale-up of services. The objective of this paper is to identify barriers to PMTCT implementation in the context of a randomized control trial on the use of structured mobile phone messages in PMTCT. Methods The preliminary analysis presented here is based on survey data collected during enrolment in PMTCT services at one of two health facilities in Nairobi, Kenya, with overall number of antenatal care (ANC) visits determined from 48 hour follow up data. Results Data was collected for 503 women. Despite significant differences in the type of facility and sample characteristics between sites, all women presented to care at 20 weeks gestation or later and 88.8% attended less than four ANC visits. PMTCT counselling at first visit had high coverage (86%), however less than a third of women (31.34%) reported receiving contraception counselling. Although 60.8% of women had reportedly disclosed their status to their partners, only 40% were aware of their partner’s status. Very few women had been tested for TB (10%) or received single dose nevirapine during their first antenatal care appointment (20%). Conclusion Revised PMTCT guidelines aim to reduce the inequity between PMTCT services in high and low resource settings in efforts to eliminate mother-to-child transmission. However, guideline implementation in low resource settings continues to be confronted with challenges related to late presentation, less than four ANC visits, low screening rates for opportunistic infections, and limited contraception counselling. These challenges are further complicated by lack of disclosure to partners. Effective scale up and implementation of PMTCT services requires that such ongoing program challenges be identified and appropriately addressed within the local context.
    Full-text · Article · May 2014 · BMC Health Services Research
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    • "The World Health Organization (WHO) lists preventing unintended pregnancies among people living with HIV as a second pillar of preventing mother-to-child transmission (PMTCT) [4]. Not only is preventing unintended pregnancies in HIV-infected women an effective strategy for reducing perinatal transmission [5] [6] [7] [8], but it is also cost saving [8] [9] and would contribute to the reduction of maternal mortality, which may be higher among HIVinfected women [10] [11] [12]. However, most PMTCT efforts to date prioritize the provision of antiretroviral (ARV) prophylaxis to HIV infected pregnant women, their infants, and safer breastfeeding strategies [4] [13] [14]. "
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    ABSTRACT: Background: Preventing unintended pregnancies among women living with HIV is an important component of prevention of mother-to-child HIV transmission (PMTCT), yet few data exist on contraceptive use among women entering HIV care. Methods: This was a retrospective study of electronic medical records from the initial HIV clinic visits of 826 sexually active, nonpregnant, 18-49-year old women in southwestern Uganda in 2009. We examined whether contraceptive use was associated with HIV status disclosure to one's spouse. Results: The proportion reporting use of contraception was 27.8%. The most common method used was injectable hormones (51.7%), followed by condoms (29.6%), and oral contraceptives (8.7%). In multivariable analysis, the odds of contraceptive use were significantly higher among women reporting secondary education, higher income, three or more children, and younger age. There were no significant independent associations between contraceptive use and HIV status disclosure to spouse. Discussion: Contraceptive use among HIV-positive females enrolling into HIV care in southwestern Uganda was low. Our results suggest that increased emphasis should be given to increase the contraception uptake for all women especially those with lower education and income. HIV clinics may be prime sites for contraception education and service delivery integration.
    Full-text · Article · Oct 2012 · Infectious Diseases in Obstetrics and Gynecology
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    • "Furthermore, the desire for permanent or long-acting contraception surfaced frequently in our interviews, often among women who were currently using less effective methods or no modern FP method and expressed considerable fears regarding contraceptive methods. These findings suggest that addressing women's FP needs, including permanent and LARC methods, must incorporate balanced reproductive health and FP counseling for people living with HIV, as well as community-based education on method safety [37, 38]. Partially in response to these findings, the cluster RCT included a training focus on counseling about and provision of long-acting reversible contraception (LARC), as well as referral for surgical sterilization. "
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    ABSTRACT: Despite increasing efforts to address the reproductive health needs of people living with HIV, a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. This study explores the fertility intentions and family planning (FP) preferences of Kenyan women accessing HIV treatment. We conducted 30 semistructured interviews and qualitatively analyzed the data with a grounded theory approach. Fears of premature death, financial hardship, and perinatal HIV transmission emerged as reasons for participants' desire to delay/cease childbearing. Participants strongly identified FP needs, yet two-thirds were using male condoms alone or no modern method of contraception. Women preferred the HIV clinic as the site of FP access for reasons of convenience, provider expertise, and a sense of belonging, though some had privacy concerns. Our findings support the acceptability of integrated FP and HIV services. Efforts to empower women living with HIV to prevent unintended pregnancies must expand access to contraceptive methods, provide confidential services, and take into account women's varied reproductive intentions.
    Full-text · Article · Jul 2012 · Infectious Diseases in Obstetrics and Gynecology
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