A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe

Abstract

ObjectivesFemale condoms are the only female-initiated HIV and pregnancy prevention technology currently available. We examined female condom counselling and provision among providers in South Africa and Zimbabwe, high HIV-prevalence countries.DesignA cross-sectional study using a nationally representative survey.SettingAll facilities that provide family planning or HIV/sexually transmitted infection (STI) services.ParticipantsNational probability sample of 1444 nurses and physicians who provide family planning or HIV/STI services.Primary and secondary outcome measuresFemale condom practices with different female patients, including adolescents, married women, women using hormonal contraception and by HIV status. Using multivariable logistic analysis, we measured variations in condom counselling by provider characteristics.ResultsMost providers reported offering female condoms (88%; 1239/1415), but perceived a need for novel female barrier methods for HIV/STI prevention (85%; 1191/1396). By patient type, providers reported less frequent female condom counselling of adolescents (55%; 775/1411), women using hormonal contraception (65%; 909/1409) and married women (66%; 931/1416), compared to unmarried (74%; 1043/1414) or HIV-positive women (82%; 1161/1415). Multivariable results showed providers in South Africa were less likely to counsel women on female condoms than in Zimbabwe (OR=0.48, 95% CI 0.35 to 0.68, p≤0.001). However, South African providers were more likely to counsel women on male condoms (OR=2.39, 95% CI 1.57 to 3.65, p≤0.001). Nurses counselled patients on female condoms more frequently than physicians (OR=5.41, 95% CI 3.26 to 8.98, p≤0.001). HIV training, family planning training, location (urban vs rural) and facility type (hospital vs clinic) were not associated with greater condom counselling.ConclusionsFemale condoms were integrated into provider counselling and care, although providers reported a need for new female-initiated multipurpose prevention technologies, suggesting female condoms do not meet all patient/provider needs or are not adequately well known or accessible. Providers should be included in HIV training efforts to raise awareness of new and existing products, and encouraged to educate all women.

Contraception coverage and methods used among women in South Africa: A national household survey

“…Some evidence indicates that many health workers hold misconceptions about interactions between contraception and antiretroviral treatment, and offer HIV-positive women different contraceptives than other women. [10,26,[65][66][67][68] Other studies, however, have found that HIVpositive and HIV-negative women have a similar methods mix and fertility goals. [26,65,[68][69][70] Integration of family planning within services for antiretroviral treatment and for prevention of motherto-child transmission holds much promise in raising contraceptive prevalence among HIV-positive women, [1,27,71] although it is not without challenges.…”

Nurses’ knowledge of and willingness to promote female condom use in Johannesburg Health District

“…At the time, new types of female condoms were not available and the providers did not see the available type as a good female barrier method. 28 The provision of contraceptive services during other primary healthcare consultations is an implementation strategy of the National Contraceptive Policy guidelines 29 to provide high-quality contraceptive services since 2001. The policy guidelines encourage more extensive use of barrier methods and emphasise that at least one female-initiated barrier method should be made available for contraception.…”

Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: an original research article

“…Providers in Zimbabwe were less likely to recommend dual method use to teenagers, indicating a potential missed opportunity to help young women protect themselves from HIV and unwanted pregnancy. We also found in a separate analysis of data from this study [28], that providers were less willing to recommend condom use to married women, even in Zimbabwe and South Africa where HIV prevalence in the general population is 14.9% and 17.3%, respectively [29]. Continued efforts to assess how to improve dual method use and support providers to talk with young and married women about dual method used are critical.…”