Integrating Family Planning in HIV Clinical Care in 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.