Changes in Providers’ Self-Efficacy and Intentions to Provide Safer Conception Counseling Over 24 Months

Abstract

High rates of fertility desires, childbearing and serodiscordant partnerships among people living with HIV (PLHIV) in Uganda underscore the need to promote use of safer conception methods (SCM). Effective SCM exist but few PLHIV benefit from provider-led safer conception counseling (SCC) and comprehensive national SCC guidelines are still lacking. Providers' self-efficacy, intentions and attitudes for SCC impact provision and should inform development of services, but there are no longitudinal studies that assess these important constructs. This study reports on changes in providers' knowledge, attitudes, motivation and confidence to provide SCC among a 24-month observational cohort of Ugandan HIV providers. Compared to baseline, providers evidenced increased awareness of SCM, perceived greater value in providing SCC, saw all SCM but sperm washing as likely to be acceptable to clients, reported consistently high interest in and peer support for providing SCC, and perceived fewer barriers at the 24-month follow-up. Providers' intentions for providing SCC stayed consistently high for all SCM except manual self-insemination which decreased at 24 months. Self-efficacy for providing SCC increased from baseline with the greatest improvement in providers' confidence in advising serodiscordant couples where the man is HIV-infected. Providers consistently cite the lack of established guidelines, training, and their own reluctance to broach the issue with clients as significant barriers to providing SCC. Despite providers being more interested and open to providing SCC than ever, integration of SCC into standard HIV services has not happened. Concerted efforts are needed to address remaining barriers by establishing national SCC guidelines and implementing quality provider training.

A clinic-based tablet application to support safer conception among HIV serodiscordant couples in Kenya: feasibility and acceptability study

“…Clinicbased tablet applications may be especially important for fertility tracking among HIV serodiscordant couples who desire provider reassurance and counseling about their peak fertility timing for condomless sex (14). In addition, HIV providers frequently report desires for increased training on safer conception counseling and have described difficulties integrating HIV prevention messages into family planning and reproductive health service delivery (48)(49)(50). SCIP study clinicians and counselors regularly used the clinic-based tablet application during counseling sessions and found that it enhanced patient-provider communication.…”

Human rights and HIV: rhetoric or determinants?

“…Nine articles referenced reproductive rights for serodiscordant couples or women living with HIV and family planning 12–20. This was also referred to by some authors as the ‘right to bear children’.…”

Training Exposure and Self-Rated Competence among HIV Care Providers Working with Adolescents in Kenya

“…39 This is supported by research showing that the degree to which an HCW considers themselves to be confident and competent performing a skill is associated with externally rated application of that skill in practice. 20,21 However, in the subset analysis of training interactions, external ratings were lower than HCW’s self-assessments, suggesting that confidence may not translate to objective competence. The patient actors rated providers especially low in communication skills, while technical reviewers noted deficiencies in clinical assessments and history-taking.…”

“…[18][19][20] Conversely, in a variety of global settings and across HCW cadres, high self-rated competence related to specific skills and content areas has been shown to be associated with accurate understanding of and willingness to discuss sensitive topics. [20][21][22][23] To inform optimal rollout of YFHS, this study examines training coverage, as well as the characteristics, facility context, and self-reported competence of HCWs working with ALWH in Kenya. An improved understanding of HCW training needs, as well as correlates of health worker competence related to adolescents, will inform training planning, with a vision toward higher quality YFHS services.…”

“…18 –20 Conversely, in a variety of global settings and across HCW cadres, high self-rated competence related to specific skills and content areas has been shown to be associated with accurate understanding of and willingness to discuss sensitive topics. 20 –23…”