Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa
| dc.contributor.author | Hoke, Theresa | |
| dc.contributor.author | Harries, Jane | |
| dc.contributor.author | Crede, Sarah | |
| dc.contributor.author | Green, Mackenzie | |
| dc.contributor.author | Constant, Deborah | |
| dc.contributor.author | Petruney, Tricia | |
| dc.contributor.author | Moodley, Jennifer | |
| dc.date.accessioned | 2015-07-30T04:10:01Z | |
| dc.date.available | 2015-07-30T04:10:01Z | |
| dc.date.issued | 2014-01-10 | |
| dc.date.updated | 2015-01-15T17:58:08Z | |
| dc.description.abstract | Abstract Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally. | |
| dc.identifier.apacitation | Hoke, T., Harries, J., Crede, S., Green, M., Constant, D., Petruney, T., & Moodley, J. (2014). Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa. <i>Reproductive Health</i>, http://hdl.handle.net/11427/13623 | en_ZA |
| dc.identifier.chicagocitation | Hoke, Theresa, Jane Harries, Sarah Crede, Mackenzie Green, Deborah Constant, Tricia Petruney, and Jennifer Moodley "Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa." <i>Reproductive Health</i> (2014) http://hdl.handle.net/11427/13623 | en_ZA |
| dc.identifier.citation | Hoke, T., Harries, J., Crede, S., Green, M., Constant, D., Petruney, T., & Moodley, J. (2014). Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa. Reproductive health, 11(1), 3. | |
| dc.identifier.ris | TY - Journal Article AU - Hoke, Theresa AU - Harries, Jane AU - Crede, Sarah AU - Green, Mackenzie AU - Constant, Deborah AU - Petruney, Tricia AU - Moodley, Jennifer AB - Abstract Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally. DA - 2014-01-10 DB - OpenUCT DO - 10.1186/1742-4755-11-3 DP - University of Cape Town J1 - Reproductive Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa TI - Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa UR - http://hdl.handle.net/11427/13623 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/13623 | |
| dc.identifier.uri | http://dx.doi.org/10.1186/1742-4755-11-3 | |
| dc.identifier.vancouvercitation | Hoke T, Harries J, Crede S, Green M, Constant D, Petruney T, et al. Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa. Reproductive Health. 2014; http://hdl.handle.net/11427/13623. | en_ZA |
| dc.language.rfc3066 | en | |
| dc.publisher.department | Women's Health Research Unit | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights | This is an open access article distributed under the terms of the Creative Commons Attribution License | * |
| dc.rights.holder | Hoke et al.; licensee BioMed Central Ltd. | |
| dc.rights.uri | http://creativecommons.org/licenses/by/2.0 | * |
| dc.source | Reproductive Health | en_ZA |
| dc.source.uri | http://www.reproductive-health-journal.com/ | |
| dc.subject.other | Reproductive Health | en_ZA |
| dc.title | Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa | |
| dc.type | Journal Article | en_ZA |
| uct.type.filetype | ||
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |