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[DAR es SALAAM] Integrating HIV counselling into family planning services does not discourage couples from seeking injectable contraceptive methods, potentially paving the way for implementation of complex HIV counseling messages in healthcare, says a study.
 
The scientists say that because of HIV prevalence, there has been concerns  over hormonal contraceptive use and the likleyhood of increased risk of HIV acquisition. The finding, therefore,  could aid the integration of HIV risk messages into family planning programmes to empower clients’ knowledge and choice of methods in Tanzania and other African countries.
 
In 2019, a large clinical trial called Evidence for Contraceptive Options and HIV Outcomes (ECHO) found no link between HIV infection and contraceptive methods including the use of an injectable called Depo-Provera. It was conducted in four African countries: Eswatini, Kenya, South Africa and Zambia.

“The study is applicable in the African context due to high rates of HIV.”

Janine Barden-O'Fallon, University of North Carolina at Chapel Hill

According to the study, the integration of HIV counselling and family planning will solve reproductive health care issues such as what contraceptive to use and equip those at risk of contacting HIV and people living with HIV with information to help them make good decisions.
 
Healthcare workers providing family planning services, the researchers say,  are hesitant to offer HIV counselling messages to their clients because of fears that they might be confused with the causation of HIV.

The clients believe that the contraceptives, especially the injectables, can expose them to HIV.
 
“Results indicate that the counselling messages did not cause a decrease in the uptake of injectable (Depo-Provera),’’ according to the study published in Plos One this month (3 April).
 
Janine Barden-O'Fallon, the study’s lead author and an assistant professor at the US-based University of North Carolina at Chapel Hill, explains that the study was conducted during the ECHO trial and aimed at generating information on how changes to HIV risk counselling may impact contraceptive uptake.
 
The study involving a survey of 471 clients and interviews with 26 healthcare providers was conducted at ten health facilities from September to November 2018 in Njombe and Iringa regions of Tanzania.
 
Researchers tested clients’ knowledge on HIV messages provided to them, condom use and their uptake of contraceptives. For the providers, the researchers assessed the feedback on the messages, knowledge and level of comfort in providing the messages.  
 
“During the family planning visit, 97.2 per cent of clients reported that HIV risks were discussed,” says the study. “As a result of the counselling, 60.3 per cent of clients reported that they plan to use condoms as a method of STI/HIV prevention.”
 
Barden-O'Fallon, a child and maternal health expert, says, “The study is applicable in the African context due to high rates of HIV, and family planning programming that are still trying to grow to meet the needs of their populations.”
 
“More emphasis should be placed on counselling messages to ensure that all users are consistently getting accurate information on their method of choice,’’ she recommends.
 
Lilian Mnabwiru, a fertility specialist at the Department of Obstetrics and Gynaecology, Muhimbili National Hospital (MNH), Tanzania, tells SciDev.Net, “The findings of this study will serve as an additional advocacy strategy for further HIV prevention. It means that we will have more couples testing for HIV.
 
“In Sub-Saharan Africa, where there is the highest prevalence of HIV, there is also a huge unmet need for contraception. Utilising the recommendations made by this study may help countries deal with both challenges successfully.” Mnabwiru adds that the use of fliers and verbal communication could be a better strategy to help clients understand HIV prevention.
If programmes are well planned and the human resource plans are well taken care of, I do not expect that health providers should feel burdened by additional services in providing HIV counselling,” explains Mnabwiru, who is also the General Secretary of the Medical Association of Tanzania.   

Mnabwiru adds that offering HIV messages could help clients decide the size of their families, make better choices on HIV control, and help prevent mother-to-child transmission of HIV.
 
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.
 

References

Janine Barden-O’Fallon and others Counselling on injectable contraception and HIV risk: Evaluation of a pilot intervention in Tanzania (PLOS One, 3 April 2020)

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