Capacity Strengthening and Training of Government Nurses on Long-acting Reversible Contraceptive (LARC) Methods in Kigali, Rwanda

Abstract

Background: In Rwanda adult women 15-49 have higher HIV prevalence rate (4%) compared to men (2%). Each year nearly half (47%) of all pregnancies in the country are unintended. Preventing unintended pregnancies among HIV positive women through family planning (FP) is the lowest cost perinatal HIV prevention strategy and contraceptive use is associated with longer survival in HIV positive women. HIV negative women enrolled in clinical trials should also avoid pregnancy. Methods: Project San Francisco (PSF) provided training in Long Acting Reversible Contraceptives (LARC) the copper IUD and Jadelle implant in 6 Kigali government clinics to enhance access to and uptake of the most effective family planning methods. From June 2009 - May 2014 PSF conducted monitoring & evaluation of LARC services in Kigali Rwanda. The overall numbers of nurses trained provision of LARC methods at the government clinics and LARC provision were measured. Results: PSF conducted 19 LARC training sessions with 59 nurses trained in IUD/Implant insertions. From 2009-2012 these nurses provided 5281 LARC methods (996 IUDs and 4285 Implants). During this period the percentage of family planning clients who requested LARC methods increased annually in the 6 target clinics: IUD provision among FP clients increased from 1% in 2009 to 1.2% in 2010 5% in 2011 and 9% in 2012. Implant insertions increased from 8.6% in 2009 to 7.1% in 2010 to 21% in 2011 and 37% in 2012. PSF continues to provide technical assistance for the provision of LARC methods and between June 2012 - March 2014 12937 (3009 IUDs and 9928 Implants) have been provided. Conclusions: When nurses are comfortable and competent with inserting LARC methods they are more likely to successfully promote and provide these methods to both HIV positive and negative clients. In turn these clients are very likely to opt for LARC when they are available. Established LARC services in government clinics enhance prong 2 of PMTCT and readiness for prevention trials.