Maternal and Child Health Unit
Despite increasing coverage and intensity of interventions to prevent the mother-to –child transmission of HIV a substantial number of new paediatric HIV infections continue to occur.
Family planning interventions to prevent unintended pregnancies among HIV-infected women and men are a neglected component of current programmes.
In partnership with the Western Cape Department of Health and the University of Cape Town School of Public Health, the DTHF will run a pilot project at three clinics. The objective is to develop and implement a simple intervention to integrate family planning into HIV care/treatment services and primary health care facilities in the Western Cape. The goal of the programme is to increase the uptake of effective family planning and reduce the occurrence of unintended pregnancies among HIV-infected women.
This pilot project is being undertaken in partnership with the Western Province Health Department with the aim to develop and implement a simple intervention to integrate family planning into HIV care/treatment services at primary health care facilities in the Western Cape.
The project is comprised of three interrelated parts:
Training. Basic training for nurses, counsellors and doctors working in HIV care and treatment services will take place. This will include the technical aspects of fertility and family planning in HIV infected individuals as well as counselling aspects related to family planning. The focus will be on the need to support the reproductive rights of HIV infected women and men.
Clinical support tools. Simple support tools will be devised to assist nurses, counsellors and doctors in counselling patients on fertility issues.
Delivering family planning interventions. Basic family planning technologies will be made available within consultation rooms where HIV care/treatment services are delivered. This will enable nurses and doctors providing HIV care/treatment to identify and address family planning needs rapidly as part of routine consultations, thus preventing the need to refer patients to separate services.
Key features of the intervention will encompass;
- The inclusion of men as part of the target population. Men play a critical role in shaping women’s fertility intentions and family planning uptake.
- Delivery through both pre-ART and ART services. While there is a strong focus of current services on ART delivery, there is a clear need to engage HIV infected women and men in pre-ART care and family planning is an important component of this.
- Follow-up family planning needs over time. The fertility intentions of HIV infected women and men are likely to change over time. With long-term follow up of patients, HIV care/treatment services are ideally positioned to identify and meet the changing needs of women and men.
In addition, patients will be linked where appropriate to other key sexual and reproductive health services that fall outside the scope of routine family planning. This includes assisted referrals for male and female sterilization, cervical cancer screening, termination of pregnancy, and early pregnancy detection.
The preliminary pilot project will operate in one urban and two rural settings. Experiences from the pilot will be valuable in refining the intervention, including training materials, clinical support tools and procedures for family planning delivery in HIV care/treatment consulting rooms. Once the pilot has been refined the interventions will be considered for broader implementation.
Anna van Esch, who previously managed the DTHF mobile units will run the pilot from the DTHF side in conjunction with the University of Cape Town School of Public Health & Family Medicine, the Desmond Tutu HIV Centre, and the Department of Health of the Provincial Government of the Western Cape.
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