Rwandan stakeholder perspectives of integrated family planning and HIV services

Wall, Kristin M.; Bayingana, Roger; Ingabire, Rosine; Ahlschlager, Lauren; Tichacek, Amanda; Allen, Susan; Karita, Etienne

doi:10.1002/hpm.2586

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…Similar to other African countries [50][51][52][53], there is consensus among stakeholders in Rwanda that HIV and family planning (FP) services should be integrated [54]. The Government of Rwanda strongly supports access to the full range of contraceptive options [55] and provides free therapeutic antiretrovirals (ARV) and PMTCT for HIV [56].…”

Section: Introductionmentioning

confidence: 99%

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

et al. 2020

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Background: When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-tochild transmission (PMTCT). Methods: In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. Results: Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at

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Section: Introductionmentioning

confidence: 99%

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

et al. 2020

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“…25 Similar findings have also been reported in a multicountry analysis of Demographic and Health Survey data among men from Chad, Ghana, Malawi, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe. 26 This may be attributed to the mature couple testing strategies 27 and community-based interventions that promote partners testing through secondary distribution of HIV self-test kits. 28,29 Further, HIV status disclosure strategies may also account for the improved testing rates among married men compared.…”

Section: Discussionmentioning

confidence: 99%

Engagement in HIV continuum of care: Another step needed to close the gap toward UNAIDS 90‐90‐90 targets among younger men in Rwanda

Rwibasira

Dzinamarira

Remera

et al. 2023

Journal of Medical Virology

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In this study, we measured Rwandan men's engagement in HIV services based on the UNAIDS 90‐90‐90 targets and assessed factors associated with linkage to HIV services. We analyzed the Rwanda Population‐based HIV Impact Assessment (RPHIA) data for 15‐ to 64‐year‐old males. We conducted bivariate analysis to assess the distribution and association of sociodemographic characteristics with UNAIDS 90‐90‐90 targets. We adjusted multivariable models to understand the effect measurement of associated factors and determine the factors that best predict the achievement of UNAIDS 90‐90‐90. Of 13 780 males aged 15–64 years who participated in the RPHIA and consented to the blood draw and HIV testing, 302 had a positive HIV result, while 301 had valid responses to all variables analyzed in this paper and were included in the analysis. We found that age group was an explanatory and predictive factor for achievement of UNAIDS 90‐90‐90. Younger men living with HIV (MLHIV) are less likely to have achieved UNAIDS 90‐90‐90 compared to MLHIV 50–64 years old: adjusted odds ratio (aOR) for MLHIV aged 15–34 years was 0.21 (0.08–0.53) and aOR for MLHIV aged 35–49 years was 0.77 (0.36–1.66). To close the UNAIDS 90‐90‐90 gap in Rwanda, innovative service delivery strategies are needed to support young MLHIV to reach 90‐90‐90.

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“…However, current policies have not yet resulted in integration nor nationwide promotion of LARC methods [ 40 , 41 ]. Data from a recent qualitative study of interviews with key Rwandan policymakers and stakeholders indicated that the best way to integrate HIV and family planning services was through development of integrated training materials, data collection tools, and advocacy and policy guidance [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

et al. 2021

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Background There is unmet need for family planning in Rwanda. We previously developed an evidence-based couples’ family planning counseling (C)FPC program in the capital city that combines: (1) fertility goal-based family planning counseling with a focus on long-acting reversible contraceptive (LARC) for couples wishing to delay pregnancy; (2) health center capacity building for provision of LARC methods, and (3) LARC promotion by community health workers (CHW) trained in community-based provision of oral and injectable contraception. From 2015 to 2016, this service was integrated into eight government health centers in Kigali, reaching 6072 clients and resulting in 5743 LARC insertions. Methods From May to July 2016, we conducted cross-sectional health center needs assessments in 30 rural health centers using surveys, key informant interviews, logbook extraction, and structured observations. The assessment focused on the infrastructure, materials, and human resources needed for LARC demand creation and provision. Results Few nurses had received training in LARC insertion [41% implant, 27% intrauterine device (IUD)]. All health centers reported working with CHW, but none trained in LARC promotion. Health centers had limited numbers of IUDs (median 10), implants (median 39), functional gynecological exam tables (median 2), and lamps for viewing the cervix (median 0). Many did not have backup power supplies (40%). Most health centers reported no funding partners for family planning assistance (60%). Per national guidelines, couples’ voluntary HIV counseling and testing (CVCT) was provided at the first antenatal visit at all clinics, reaching over 80% of pregnant women and their partners. However, only 10% of health centers had integrated family planning and HIV services. Conclusions To successfully implement (C)FPC and LARC services in rural health centers across Rwanda, material and human resource capacity for LARC provision will need to be greatly strengthened through equipment (gynecological exam tables, sterilization capacity, lamps, and backup power supplies), provider trainings and follow-up supervision, and new funding partnerships. Simultaneously, awareness of LARC methods will need to be increased among couples through education and promotion to ensure that demand and supply scale up together. The potential for integrating (C)FPC with ongoing CVCT in antenatal clinics is unique in Africa and should be pursued.

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Rwandan stakeholder perspectives of integrated family planning and HIV services

Cited by 8 publications

References 14 publications

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

Engagement in HIV continuum of care: Another step needed to close the gap toward UNAIDS 90‐90‐90 targets among younger men in Rwanda

Cross-sectional assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

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