REPRODUCTIVE HEALTH RELATED DATA FROM ICAP-SUPPORTED

PROGRAMS• Annual survey of HIV care and

treatment facilities• Pilot of a family planning screening

questionnaire (FPSQ) in HIV care and treatment facilities in Rwanda

• Sexual and gender-based violence (SGBV) program in Rwanda

ANNUAL SURVEY OF HIV CARE AND TREATMENT FACILITIES

WHILE THE MAJORITY OF HIV CARE AND TREATMENT CLINICS CONDUCT (FP) COUNSELING, FAR FEWER PROVIDE

METHODS ASIDE FROM MALE CONDOMS, SEPTEMBER 2011 (N=790)

FP COUNSELING REGARDING FEMALE CONDOMS AND ORAL CONTRACEPTIVES IS

MORE COMMON IN RURAL CARE AND TREATMENT CLINICS, SEPTEMBER 2011

(N=790)

PROVISION OF ORAL CONTRACEPTIVES MORE COMMON IN RURAL CARE AND TREATMENT

CLINICS, SEPTEMBER 2011 (N=790)

PILOT OF A FAMILY PLANNING SCREENING QUESTIONNAIRE (FPSQ) IN HIV CARE AND TREATMENT CLINICS IN

RWANDA

BACKGROUNDICAP collaborated with MOH to design a simple four-item FP screening questionnaire (FPSQ) for use among adults enrolled in HIV care and treatment

SCREENING ALGORITHM

MOST SEXUALLY ACTIVE PATIENTS ENROLLED IN HIV CARE OR ON ART USE

MODERN FP, WITH WOMEN SLIGHTLY MORE LIKELY TO USE THAN MEN (N=442)

P=0.014

Women (n=274)

MALE CONDOMS AND INJECTABLES ARE MOST COMMON FP METHODS USED BY

SEXUALLY ACTIVE PATIENTS NOT DESIRING PREGNANCY IN THE NEXT 12 MONTHS

(N=355)

Men (n=81)

SEXUAL AND GENDER-BASED VIOLENCE (SGBV) PROGRAM IN

RWANDA

PROGRAM OVERVIEW• Implement a one-stop model center for delivery of all

relevant services to SGBV survivors in 9 district hospitals

• Creating a package of rape care and treatment services• HIV testing at initial and 3-month follow up visits• PEP• STI prophylaxis• Emergency contraception• Medical care• Psychological counseling

• Recruitment of specialists and training of existing providers on SGBV related services

• Conducted national community campaign to raise awareness about SGBV and the services available to SGBV survivors

NUMBER OF SGBV VICTIMS AND SERVICES OFFERED, JANUARY 2010-

OCTOBER 2011

75% <18

2 % HIV+

29 % pregnant

80 % received

PEP

53 % received EC

REPRODUCTIVE HEALTH RELATED DATA FROM ICAP-SUPPORTED

STUDIES• National prevention of mother-to-child

transmission program (PMTCT) evaluation in Rwanda

• Prevention in Care and Treatment Settings (PiCTS) Study in Kenya, Namibia, Tanzania

14

NATIONAL PREVENTION OF MOTHER-TO-CHILD TRANSMISSION PROGRAM

(PMTCT) EVALUATION IN RWANDA

STUDY OVERVIEW

• Cross-sectional survey explored pregnancy intentions, and family planning knowledge and use in 12 randomly selected public-sector ANC providing PMTCT services

• 236 HIV+ and 162 HIV- postpartum women completed close-ended interview within 12 months of their expected delivery date

THE MAJORITY OF WOMEN REPORTED THAT ANC STAFF DISCUSSED FP

DURING/AFTER LAST PREGNANCY

18

HIV+ WOMEN LESS LIKELY THAN HIV- WOMEN TO DESIRE MORE CHILDREN

(N=398)

Elul et al., AIDS 2009.

19

HIV+ WOMEN MORE LIKELY THAN HIV- WOMEN TO HAVE KNOWLEDGE ABOUT

MODERN FP METHODS (N=398)

Elul et al., AIDS 2009.

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AMONG THOSE WHO WANT TO LIMIT CHILDBEARING, HIV+ WOMEN MORE

LIKELY THAN HIV- WOMEN TO REPORT USE OF MODERN FP METHODS (N=281)

Elul et al., AIDS 2009.

PREVENTION IN HIV CARE AND TREATMENT SETTINGS (PICTS) STUDY

IN KENYA, NAMIBIA, TANZANIA

STUDY OVERVIEW

• Multi-country, multi-site quasi-experimental study to evaluate a package of HIV prevention interventions for PLHIV

– Management of sexually transmitted infections

– Family planning

– Use of lay counselors to deliver positive living messages

– HIV prevention messages given by health workers

• HIV care and treatment clinics (n=18) enrolled 3,547 sexually active HIV-infected patients

• Baseline questionnaires collected information on family planning use and fertility desires

WOMEN MORE LIKELY THAN MEN TO REPORT THAT A HEALTH CARE PROVIDER DISCUSSED

FP IN THE HIV CLINIC (N=3,475)

Mbatia et al., IAS 2011.

MAJORITY OF WOMEN AND MEN WANT TO AVOID PREGNANT IN THE NEXT 6

MONTHS (N=3,375)P<0.05

Mbatia et al., IAS 2011.

FACTORS POSITIVELY ASSOCIATED WITH NOT DESIRING PREGNANCY IN NEXT 6 MONTHS

AMONG WOMEN AND MEN IN MULTIVARIATE ANALYSIS (N=3,297)

• Knowing partner is HIV+ or not knowing partner status

• Partner violence >6 months ago • Low engagement in decision making about

their own reproduction• Discussing family planning with a health care

provider

Antelman et al., IAS 2011.

WOMEN REPORT DIVERGENT PREGNANCY DESIRES AMONGST THEMSELVES AND THEIR

SPOUSES (N=3,130)

P<0.05

Mbatia et al., IAS 2011.

SIGNIFICANT UNMET NEED FOR DUAL PROTECTION* AMONG WOMEN AND

MEN WHO WANT TO AVOID PREGNANCY IN THE NEXT 6 MONTHS (N=2,661)

* Highly effective modern FP method (e.g. oral contraceptives, injectables, IUD, implants, permanent methods) + condoms

P<0.05

Mbatia et al., IAS 2011.