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Improving CPI: Responding to Client’s Family Planning Needs in HIV/AIDS Service Settings


March 5 to 16, 2007
http://my.ibpinitiative.org/fphivintegration 

This two-week forum provided up-to-date and state-of-the-art information on what is happening in the field and an opportunity for synergy between sharing global best practices and country-based experiences. This forum immediately followed a multi-country videoconference of the same title.

Discussion Statistics


Number of participants:  394
Number of participants' countries: 61   
Number of contributions: 22
% of contributions from developing countries: 32%
Number of countries contributing: 7

Contributing countries: Israel, Ethiopia, Ghana, Zambia, Sierra Leone, USA, Bolivia)

Purpose and Objectives 
Two participants posted contributions today. One participant from Zambia described a program called "Circle of Friends" where satisfied family planning users are able to recruit non-contraceptive users and introduce them to a family planning provider who would counsel them and provide a method. Another participant from Sierra Leone described common misconceptions about contraceptive methods including the intrauterine device (IUD) and condoms and posed a question to the experts.

                                                       

Day 1. Summarizing the videoconference presentations
We begin the discussion by summarizing the three presentations from the March 1, 2007 videoconference on the same topic. The presentation titles follow:

  • Contraceptive Needs and Preferences of PMTCT Clients in South Africa, Dr. Jennifer Moodley, Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town
  • Integration Prevention, Counseling and Testing for HIV into Family Planning Services in South Africa, Dr. Saiqa Mullick, Population Council (Frontiers)
  • Integration of RH/FP and HIV/AIDS Activities: Experience of Pathfinder International from Implementing Best Practices (IBP) and Other Initiatives, Dr. Mengistu Asnake, Pathfinder International

  1. Jennifer Moodley mentioned in her presentation at the videoconference that the HIV+ women they observed in South Africa seemed to have misconceptions about the safety of some contraceptive methods. In your own experience, do women in your country have similar fears and misconceptions about the safety of some methods? If so, which methods? What are their fears? How have you or other providers tried to change their misconceptions?
  2. Saiqa Mullick described a "Balanced Counseling Strategy” (BCS) approach to family planning in her presentation at the videoconference. In this strategy, the client is given information about a range of family planning methods available and the provider helps the client make a choice from appropriate contraceptive methods. The provider is trained to use an algorithm to help narrow down the choices and is equipped with job aids and communication materials to share with the client. At the same time, providers are trained to stress the importance of condom use for dual protection. In your own experience, how often do providers spend time helping clients decide on which family planning method is best for them? What is the best way to explain dual protection to clients who have selected other family planning methods?
  3. Dr. Asnake from Ethiopia talked about a strategy for reducing stigma and discrimination. He explained that, before training, many voluntary counseling and testing (VCT) counselors believed that HIV+ clients should abstain from sex completely. They did not even see a reason for discussing family planning with their HIV+ clients. After receiving training, counselors in VCT clinics were able to provide their clients with condoms and pills directly and refer them to other sites for other family planning methods. In your own experience, either as a provider or client, have you seen examples of provider discrimination and insensitivity to HIV+ clients? What has been done in programs in your country to address this problem
  4. Click on the full text daily digest below for full summaries. Two participants also posed questions related to the above presentations.
                                                      
Day 2. Case study on client-provider interaction

Questions:

  1. What are some of the things that you, as a provider, try to remember when counseling your clients?
  2. What experiences have you had as a client that illustrate good or bad counseling?

Day 2 Summary:

On Day 2, we presented a case study on client-provider interaction. This scenario presents a situation in which an HIV+ woman visits an HIV provider looking for information about family planning. It also demonstrates some of the principles of good client-provider interaction and counseling principles. Participants were asked to read the case study and respond to specific questions about the scenario.

A participant from Ghana also posted a contribution highlighting three important topics; 1) common misconceptions about contraception; 2) integrating FP into ART services; and 3) provider training on stigma reduction strategies.
 


Day 3.
Two participants posted contributions today. One participant from Zambia described a program called "Circle of Friends" where satisfied family planning users are able to recruit non-contraceptive users and introduce them to a family planning provider who would counsel them and provide a method. Another participant from Sierra Leone described common misconceptions about contraceptive methods including the intrauterine device (IUD) and condoms and posed a question to the experts.

                                             
Day 4.
Guest expert, Dr. Moodley, responded to the question posed by the participant from Sierra Leone. Another participant asked Dr. Moodley some questions about her presentation at the March 1 videoconference. Dr. Heidi Reynolds from FHI also described the Kenyan Ministry of Health’s approach in integrating FP into VCT and asks for people’s thoughts on this approach.

Days 5

Several participants posted comments today. Theresa Hatzell Hoke from FHI, USA talked more about the study presented by Dr. Moodley and asked others about provider misconceptions. Dr. Moodley also provided answers to Dr. Yoder's questions included in the last digest. Dr. Young-Mi Kim from JHU/CCP, currently working in South Africa, talked about FP counseling in ART settings and Violeta Ross from Bolivia talked about women living with HIV. Yvonne Morgan from Sierra Leone discussed the case study presented early last week. Jeanne Keller and Arnitra, both from the US, provided ideas on how to counsel the 15 year old client discussed last week.


Days 6

Today's daily digest contains the personal story of Kimberly who found out that she was HIV positive in 1990. Kimberly has shared with us some of her experiences, including dealing with her diagnosis, disclosing her status, and her interaction with providers.


Days 7

Today we received Kimberly's responses to the questions that a forum participant asked earlier this week. 


Days 8

This forum has been a rich and rewarding experience; we have exchanged ideas as well as personal and programmatic experiences. One of the purposes of this forum was to facilitate ongoing networking and dialogue among program managers, researchers, and others interested in improving CPI as it relates to clients’ FP needs within HIV/AIDS service settings. We hope that this forum has provided you with up-to-date and state-of-the-art information on what is happening in the field and an opportunity for synergy between sharing both global and domestic-based experiences.


Post-forum survey results

Number of surveys completed 31

% who have passed content to others 66%

% who have or will use in their work  74%

% very satisfied with forum content 67%

Suggestions for improvement :  

  • Involve more providers in the discussion.
  • Less attention to individual, anecdotal experience and more information about practices that are proposed, being piloted, or being fully implemented in service delivery.

  Other comments:

  • The forum brought me a lot of information and some experience from colleagues from other developing countries.
  • The topics discussed were interesting, but I would have liked to have read a broader range of topics.
  • Sharing from the patients themselves is a great learning [experience]! My perspective to communicate and work with RH and HIV has widened and makes me better [prepared] to plan and work on RH/HIV.
References and resources

Click here for related resources and references in the community library

Reports and publications

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Organizing groups

Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU/CCP), with support from the Implementing Best Practices in Reproductive Health Initiative (IBP) Initiative, the USAID Maximizing Access and Quality Subcommittee on Client Provider Interaction (CPI), and the USAID Family Planning and HIV/AIDS Integration Working Group

Contributing experts/facilitators 

Dr. Jennifer Moodley, Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town

Dr. Saiqa Mullick, Population Council (Frontiers)

Dr. Mengistu Asnake, Pathfinder International

Kimberly, USA, HIV+ Client

Steering committee

This online forum builds upon existing partnerships and activities among three groups: the Implementing Best Practices in Reproductive Health Initiative (IBP) Initiative, the USAID Maximizing Access and Quality Subcommittee on Client Provider Interaction (CPI), and the USAID Family Planning and HIV/AIDS Integration Working Group

Other acknowledgements

We would like to thank Dr. Arzum Ciloglu and Marian Amoa of the Health Communication Partnership and Peggy D’Adamo and Megan O’Brien of the INFO Project who coordinated this online forum.

Moderators

Megan O’Brien, JHU/CCP