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

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

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  1. 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

  2. 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

  3. 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.

  4. 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

  5. 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)

  6. Clients’ fertility desires

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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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