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Challenge:                                                                                                                                                                                                Family planning is one of the most cost-effective strategies to prevent the spread of HIV. In sub-Saharan Africa, current contraceptive use averts the births of an estimated 190,000 HIV-infected infants each year. An additional 120,000 could be averted per year by preventing all unintended pregnancies among women with HIV. Yet while many HIV programs focus on costly antiretroviral (ARV) medication to women who are already pregnant, few devote resources to reducing the high unmet need for family planning among women with HIV.

 

In Uganda, where approximately 8% women between the ages of 15-49 have HIV, EngenderHealth's USAID-funded ACQUIRE Project identified a gap in services for this population. To address this gap, ACQUIRE partnered with The AIDS Support Organization (TASO) to provide technical assistance to one of its ART centers in an eastern district. Most of the center’s staff had not received any training in family planning options for women with HIV, and ART services did not include family planning counseling or method provision. Providers were concerned these services would encourage sexual activity. In addition, community members thought that contraceptives may have harmful side effects for women taking ARVs.

 

Using “Family Planning Choices for Women With HIV,” a recent issue of Population Reports published by the INFO Project at the Johns Hopkins Bloomberg School of Public Health, ACQUIRE developed a rapid-response training program on integrating family planning into HIV services. ACQUIRE distributed the new Population Report, which highlights clear, actionable key points, to providers and community nurses. The report emphasized that, contrary to what many providers believed, most women with HIV can safely use nearly any method of family planning, including long-acting methods such as intrauterine devices (IUDs). Using Population Reports, health care providers and program managers learned that preventing unplanned pregnancies is one of the most cost-effective strategies for preventing mother-to-child transmission (MTCT) through family planning how preventing unplanned pregnancy is a key strategy for preventing MTCT, a important consideration since ARVs for preventing MTCT may be limited to the 40% of Ugandan women who deliver their infants in hospitals. Breastfeeding, another big factor in mother-to-child transmission, is nearly universal in Uganda.

 

Providers and programmers participating in the ACQUIRE training used Population Reports' guidance on family planning options for women with HIV in several key ways, according to Dr. Henry Kakande, ACQUIRE's technical manager in Uganda. Staff learned about the importance of supporting the reproductive decisions of women with HIV. Trainers used the report to teach counseling strategies to help HIV-positive women talk with their partners about contraception. Nurses learned to provide family planning as a comprehensive package for home-based HIV care. Since the training, TASO staff began speaking with clients about family planning messages while clients wait for ART services.