184919 Integrating Family Planning in HIV Clinical Care in Ghana

Wednesday, October 29, 2008

Olivia Aglah, MPH , Quality Health Partners / EngenderHealth, Accra, Ghana
Kerry Bruce, MPH, MA , Quality Health Partners / EngenderHealth, Accra, Ghana
Peter Preko, MD, MPH , ICAP-Swaziland, Columbia University, Eveni, Swaziland
Edward Bonku, MD, MPH , Quality Health Partners / EngenderHealth, Accra, Ghana
Richard Killian, MPH , Quality Health Partners / EngenderHealth, Accra, Ghana
Background: Ghana's ART program currently has over 8,000 clients on treatment, 66% of whom are women of reproductive age. Improvements in health as a result of ART, the cultural and social pressures related to fertility and the challenges of partner notification have led to unplanned pregnancies among PLHIV. In 2005, 40% of women wanted to discuss family planning (FP) with their doctor, but still few PLHIV are accessing FP services.

Design/Intervention: FP providers from 15 facilities were trained in stigma reduction, improved infection prevention practices, and contraceptive technology updates. ART physicians and adherence counsellors were briefed on the importance of discussing FP with their clients and referring accordingly. Reminder stickers were placed in client records to remind ART providers to explore FP needs clients. Brochures on FP and ART were distributed for clients to read and improve their knowledge. A community level FP peer education program created demand and referred clients to trained FP providers.

Results: Early results show that stickers have been effective in reminding providers to explore FP needs with clients and that training for providers has increased the numbers of clients seeking FP services. However, the number of pregnancies in this population continues to rise.

Conclusions: The growing interest among ART clients to have children indicates a need for new initiatives to provide information to clients on planning safe pregnancies coupled with access to non-stigmatizing FP services. The availability of routine FP services alone will not entice PLHIV to participate.

Learning Objectives:
1. To understand how to effectively integrate family planning services into HIV clinical care in a resource poor setting. 2. To reflect on some of the unintended consequences of ART treatment on women’s childbearing intentions.

Keywords: Family Planning, Antiretroviral Combination Therapy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the program implementer for FP-ART integration for the past three years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.