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APHIA II RIFTVALLEY APHIA II COAST Integration of family planning (FP) into PMTCT services in Kenya Jennifer Liku , Rose Otieno-Masaba, Marsden Solomon, Maureen Kuyoh, Elizabeth Jackson, Ambrose Juma ICFP: Kampala, Uganda November 15-18, 2009 Background

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APHIA II

RIFTVALLEY

APHIA II

COAST

Integration of family planning (FP) into PMTCT services in Kenya

Jennifer Liku, Rose Otieno-Masaba, Marsden Solomon, Maureen Kuyoh, Elizabeth Jackson, Ambrose Juma

ICFP: Kampala, Uganda

November 15-18, 2009


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Background

  • Mother to child transmission of HIV (MTCT) can occur during pregnancy, labor, delivery and breastfeeding

    • family planning services can sharply increase the number of HIV infections averted among infants from 39,000 to over 70,000

  • Prevention of Mother to Child Transmission (PMTCT) being implemented as part of HIV programs

  • World Health Organization promotes a four-pronged comprehensive approach aimed at preventing MTCT to optimize effectiveness of PMTCT


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Role of FP in HIV Prevention

Family planning and effective use of contraceptives

Prevention of HIV in women, especially young women

Prevention of unintended pregnancies in HIV-infected women

Prevention of trans-mission from an HIV-infected woman to her infant

Support for mother and family

Source: WHO, 2002.


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Rationale for strengthening FP in PMTCT

FP services within PMTCT provide opportunity for all women (HIV infected and uninfected) to make informed reproductive health decisions

FP services necessary after delivery

Most HIV-infected women in developing countries do not know their serostatus

increased availability of counseling and testing services would enable them to obtain essential care and support services including FP


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Current status

In spite of the rapid scale up of Kenya’s national PMTCT program in antenatal and maternal child health clinics where FP is an integral part of services, use of effective contraception remains an unexploited intervention among patients in child welfare and post natal clinics

An assessment of FP services in PMTCT settings (2008) revealed high levels of unmet need for FP and inadequate screening for unintended pregnancy among clients (see next slide)



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Goal

To work with the Ministry of Health and other partners to integrate and strengthen family planning in labor/maternity wards, ANC, PNC, and CWC thereby increasing the opportunity of women hearing about and getting services on family planning


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Objectives

Ensure PMTCT training materials are reviewed to include provision of FP for HIV positive women and FP discussion with all PMTCT clients

Pre-test the revised PMTCT training materials with trainers and service providers

Create more awareness amongst service providers on the benefits of family planning among HIV positive women and couples

Review data collection tools in ANC, labor and maternity wards, CWC, and PNC to ensure provision of family planning services and record keeping

Monitor the provision and uptake of family planning services within maternity, PNC and CWC units


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Intervention

MOH and FHI to strengthen FP in maternity wards, antenatal and child welfare clinics to increase women’s access of FP by:

strengthening a FP module within the revised PMTCT curriculum

assessing data capture tools to determine provision of FP services

field testing, revising and printing PMTCT training materials

training service providers and orientating program managers and facility in-charges on strengthening FP in PMTCT

ensuring support and supervision of comprehensive PMTCT services


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Specific activities

Review of PMTCT-FP training materials

Assessment of data capture tools (baseline data)

Field-test, revise and print materials

Train service providers in selected sites

Conduct orientation of PMTCT Program Managers and Clinic In-charges on FP- PMTCT

Collect service statistics to monitor FP uptake


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Baseline: Assessment of FP services in PMTCT sites

Data from 20 randomly selected facilities in Coast and Rift Valley provinces

12/20 had a designated room for FP

13/20 have a provider trained on RH-HIV integration

12/20 have providers trained strengthening FP in PMTCT

11/20 reported having comprehensive record keeping tools

In all facilities, pills, injectables and condoms discussed and offered

Provision of FP information in labor and delivery units not common

2/20 facilities offer services


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Lessons learned

Earlier efforts to integrate FP counseling and referral in maternal and child health (MCH) provide greater access for FP services

Training of providers is necessary to update family planning knowledge and skills

Managers of health facilities have a role to play in strengthening FP service provision in all MCH services

Targeting clients with FP information at all service units is necessary to reduce missed opportunities for pregnancy and HIV prevention


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Acknowledgements

Division of Reproductive Health (DRH)

National AIDS and STI Control Programme (NASCOP)

AIDS, Population & Health Integrated Assistance (APHIA) II Coast and Rift Valley provinces

Funded by USAID


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