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Key Points
- Family planning is being integrated into one of the world's largest HIV projects.
- HIV project staff members recognize that their clients need family planning services.
- Providers of family planning and of HIV services are trained for HIV-positive clients.
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Family planning services and HIV care and treatment are usually offered separately, resulting in many missed opportunities to address clients' needs.
But that is beginning to change. One notable example is the Global HIV/AIDS Initiative Nigeria (GHAIN), which has begun training its providers of HIV services in family planning.
This step is significant because GHAIN is the largest comprehensive HIV/AIDS project ever carried out in a single developing country, supporting HIV prevention, care, and treatment services in 36 hospitals in 22 states.
GHAIN is funded by the President's Emergency Plan for AIDS Relief, with additional funds from the Global Fund for Tuberculosis and Malaria, the Shell Petroleum Development Corporation, and the Clinton Foundation, among others. The U.S. Agency for International Development supports GHAIN to integrate reproductive health services with HIV prevention and treatment services.
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Photo credit: GHAIN/FHI |
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Nursing mothers listen to a GHAIN health educator in Kano, Nigeria. By September 2007, GHAIN had provided antiretroviral treatment to more than 14,000 people. In its first three years, the project also gave counseling and HIV test results to almost 700,000 people and provided a complete course of antiretroviral prophylaxis to more than 4,300 women. |
In October 2005, GHAIN sent a consultant to a workshop that FHI held in South Africa to introduce its training module, Contraception for Women and Couples Living with HIV. Afterward, the consultant worked with GHAIN staff members to adapt the module into a training guide for Nigerian health care providers. Modules from the guide were then incorporated into the project's training sessions for providers of antiretroviral treatment (ART), HIV counseling and testing (CT), and services to prevent mother-to-child transmission (PMTCT) of HIV.
At first GHAIN focused on developing integrated services and providing training at 14 hospitals in Lagos State and the Federal Capital Territory. But GHAIN's technical advisors saw a need to expand the integrated training beyond those sites, particularly for PMTCT.
"Family planning is already part of PMTCT, but it was not a strong component," said Nnenna Mba-Oduwusi, GHAIN's family planning-HIV-integration advisor. "I think it was just assumed that these providers would be up to date."
Now all GHAIN training sessions include content on family planning and contraceptive counseling. "Every time GHAIN establishes a new site, we have to train providers," said Mba-Oduwusi. "And every time that training takes place, it also includes the family planning training."
This training is designed to ensure that those providing HIV counseling and testing are able to give clients accurate information about their contraceptive options and to refer them to appropriate family planning services. PMTCT and ART providers receive more comprehensive training that includes a thorough grounding in the medical eligibility criteria for contraceptive use by HIV-infected women and couples.
GHAIN's technical advisors discovered that most family planning providers did not know how to advise HIV-positive clients. So GHAIN now offers family planning providers at the integrated sites a two-day training course that covers HIV issues such as confidentiality and stigma, as well as contraception for people living with HIV.
At the integrated sites, GHAIN strengthens systems for referring clients between HIV and family planning services and monitors integration efforts. The results will help guide further expansion to a total of 24 sites.
By September 2007, which marked the end of the first year of training, a total of 638 GHAIN providers had been trained in integrated services and more than 100 trained staff members were providing integrated services at the 14 integrated sites. Data from those sites shows that 611 ART, PMTCT, and CT clients had received family planning counseling or services, and family planning providers had referred more than 1,400 clients for HIV counseling and testing.
