Provider perspectives on barriers to reproductive health services for HIV-infected clients in Central Malawi.

Margaret R Caplan,Khumbo Phiri,Risa M Hoffman,Ann Phoya,Alan Schooley,Julie Parent

doi:10.15761/cogrm.1000208

Abstract

Despite widespread availability of Depo-Provera in HIV clinics in Malawi, coverage of family planning (FP) remains low. We sought to understand provider perspectives about the challenges of providing reproductive health services to HIV-infected clients in antiretroviral therapy (ART) clinics in Central Malawi by conducting surveys and semi structured in-depth interviews with 31 ART providers across 16 clinical sites. Additionally, site surveys were performed to assess contraceptive resources. Major barriers to the provision of FP in ART clinics were inadequate staff in the facility, shortage of trained providers, limited time to counsel on FP, and lack of private space for the provision of FP services. These barriers limit the direct delivery of FP in ART clinics. Strategies to integrate FP with HIV/ART services and task shifting FP service provision to non-ART providers should be explored in Malawi as a means to improve coverage of services to HIV-infected clients.

Highlights

HIV/AIDS is the leading cause of death in women of childbearing age worldwide [1], and HIV-infected women carry an estimated 2 to 10 times higher risk of dying during pregnancy and the postpartum period compared to HIV-uninfected women [2,3,4]
In a survey of 200 HIV-infected women presenting to an HIV/antiretroviral therapy (ART) clinic in Lilongwe, Malawi, over two-thirds of the women reported that their last pregnancy was unintended and less than 10% were using hormonal contraception [8]
We sought to better understand barriers and facilitators to the delivery of Family planning (FP) services among providers working in ART clinics in Central Malawi

Summary

Introduction

HIV/AIDS is the leading cause of death in women of childbearing age worldwide [1], and HIV-infected women carry an estimated 2 to 10 times higher risk of dying during pregnancy and the postpartum period compared to HIV-uninfected women [2,3,4]. Addressing FP and other reproductive health needs is essential to health promotion and disease prevention in HIV-infected women and men; despite the recognition of its importance, there are large gaps in the provision of FP services in Sub-Saharan Africa [7]. Understanding reasons for gaps in FP is important for effective implementation of services to improve HIV care. The data suggested that providers have complex perspectives surrounding the issue of reproductive health services, possibly stemming from limited knowledge about risks of transmission of HIV to infants during pregnancy and lack of information about family planning and safer conception [12]. Building on our previous work, the current study performed individual in-depth interviews with HIV providers in Malawi who provide FP and ART services.

Methods

Results

Discussion

Conclusion