Preparing for HIV Prevention Trials: From Training to Service Delivery-lessons Learned with Long Acting Reversible Contraception (LARC) in Zambia

Abstract

Background: Zambia has a high burden of mother-to-child transmission of HIV. The provision of long-acting reversible contraceptives (LARC) specifically intra-uterine devices (IUDs) and Jadelle implants is critical to prevent unplanned pregnancy and perinatal transmission in HIV+women and is also necessary to prevent pregnancy in HIV- prevention trial participants. The UK Department for International Development has funded a program to avert an estimated 13900 new HIV infections through integrated PMTCT with LARC and HIV couples-focused HIV testing. Methods: LARC training for providers began with a 3-day didactic training followed by supervised IUD and Jadelle insertion and removal practicums. Those showing proficiency in all 4 categories were considered fully certified. Practicums were conducted at government clinics in Copperbelt Lusaka and Southern Province. Results: From June 2013 to March 2014 ZEHRP trained 199 LARC providers from 45clinics. 91% were certified in Jadelle insertions 70% in Jadelle removals 55% in IUD insertions 46% in IUD removals and 43% were fully certified. The main obstacles to completion of practicums were not being assigned to the family planning department when one of the few trainers was available and coordinating these times with availability of interested LARC clients. A Training-of-Trainers was held for the fully certified nurses who were high performers meetings were held with clinic in-charges to coordinate trainee schedules and satisfied clients were recruited to give personal testimonials. Conclusions: IUD and implants are rarely used in Africa primarily because lack of supply leads to lack of demand. This model illustrates an effective way to harness successful LARC trainees as trainers and work with clinic administrators and satisfied clients to coordinate practicum training and demand creation. Repeating this cycle leads to a snowball effect of progressive and simultaneous increase in supply and demand resulting in PMTCT and trial-ready clients with LARC.