Abstract
Malawi's guidelines for Clinical Management of HIV in Children and Adults promote the practice of provider-initiated family planning (PIFP) for all clients over the age of 15. The guidelines recommend that providers should offer all clients condoms, offer injectables to female clients, and refer clients to another provider or site if clients prefer another family planning method. This study assessed to what extent family planning services had been integrated into HIV services among 41 facilities in Malawi (hospitals, health posts, health centers; public and nonprofit private) and how the reproductive rights of people living with HIV were being addressed. Data were collected through facility audits (N=41), provider interviews (N=122), client exit interviews (N=425), and mystery client visits (N=58). This study found that contrary to clinical protocols, only 14% of clients at the antiretroviral therapy (ART) clinic had reported being asked about their family planning/fertility intentions during the visit that day. Only 24% of providers at the facility had received training on family planning-HIV integration, and 21% had no family planning training at all. Overwhelmingly, ART clients relied on condoms to meet their family planning needs. Only 24% of ART clinics had injectables available, and only 15% of ART clinics had a full range of family planning methods (short- and long-acting, hormonal and non-hormonal) available to clients. These findings suggest that Malawi's strong national policies on family planning-HIV integration, and specifically PIFP, are not being implemented in practice and thus not adequately addressing the family planning needs of clients with HIV. To improve PIFP, Malawi requires targeted systems changes. Facilities need to broaden their family planning method mix offerings. Furthermore, providers need more training on family planning and the importance of HIV clients having access to family planning services, and referral services need to be strengthened so providers can ensure clients have access to their method of choice in a timely manner.
Highlights
What Is Provider-Initiated Family Planning?Global Health: Science and Practice 2019 | Volume 7 | Number 4 opportunity to offer family planning.”[2]
Malawi should be recognized as an early adopter of provider-initiated family planning (PIFP) within its HIV-management guidelines, 4 years after adopting these guidelines, implementation of PIFP was largely unrealized at the clinic level
In 2016, Malawi issued a third edition of its Clinical Management of HIV in Children and Adults, which maintained PIFP as a protocol during antiretroviral therapy (ART) services
Summary
Global Health: Science and Practice 2019 | Volume 7 | Number 4 opportunity to offer family planning.”[2] a comprehensive review of over 2,500 articles shows that promoting voluntary family planning as part of routine HIV services is the number one evidence-based practice on how to meet the sexual and reproductive health needs (and rights) of women living with HIV.[3]. In 2007, the World Health Organization established global guidelines on PICT for HIV, which encourages providers to routinely offer HIV testing as part of standard medical care for all patients in the context of a generalized HIV epidemic.[4] PICT takes an “opt-out” approach, in that clients must decline the test. Studies have shown a positive correlation between PICT and an uptake in HIV testing and condom use; as a programmatic intervention, PICT has been instrumental in increasing the number of people being tested for HIV and using condoms for HIV prevention.[5].
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