Provider attitudes about childbearing and knowledge of safer conception at two HIV clinics in Malawi

Abstract

BackgroundThere is limited understanding of health care providers’ attitudes towards HIV-infected individuals’ reproductive choices, as well as knowledge about safer conception. Our study objective was to explore provider-level factors that serve as barriers and/or facilitators to the provision of reproductive and safer conception services for men and women living with HIV.MethodsTwenty-five providers were interviewed in four focus group discussions about their attitudes regarding childbearing by HIV-infected clients, reproductive health and HIV knowledge, and views and knowledge of safer conception.ResultsProviders reported ambivalence about supporting childbearing among their clients with HIV. They raised concerns about HIV-infected individuals having children, and in certain cases expressed judgment that people with HIV should not have children because of these concerns. Providers lack specific knowledge about safer conception strategies and have low level of knowledge of reproductive health, the efficacy of PMTCT, and the risks of pregnancy for HIV-infected women.ConclusionsProviders in our setting have complex attitudes about HIV-infected clients having children and lack knowledge to appropriately counsel clients about reproductive health and safer conception. Our findings highlight need for further research in this area as well as the need for provider training in reproductive health and safer conception.

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

“…For providers, availability was limited by: lack of training in SCSs, SCS service delivery, and preconception counselling for people living with HIV; health workforce shortages that limited the quality of counselling; poor linkages to HIV care; and lack of integration of HIV and reproductive health services (leading providers to think that SCS is someone else’s responsibility) [22, 24, 27, 35, 47–51]. Studies showed that provider training and self-efficacy in talking about SCS increased SCS availability [35].…”

“…Thirteen studies were qualitative assessments of healthcare providers and people living with HIV or serodiscordant couples. Several studies found that providers rarely initiated discussion of fertility intentions and reproductive goals with HIV-affected clients during visits [24, 39, 41, 42, 46, 50, 58, 65]. When fertility intentions were assessed, usually only the woman’s reproductive goals were discussed and not the man’s or couples [58, 61].…”

“…However, PrEP access is increasing in East and Southern Africa, and sperm washing may become available in other high HIV incidence settings with ongoing efforts to develop lower-cost technologies [30, 37, 46, 69]. Several studies demonstrated the need for increased provider training on SCS to increase availability to services [24, 45, 48–51, 70] and additional studies demonstrating the efficacy of SCS provider training curricula in different settings, such as the Safer Conception Counseling Tooklit [54], are warranted.…”

A Novel Safer Conception Counseling Toolkit for the Prevention of HIV: A Mixed-Methods Evaluation in Kisumu, Kenya

“…While evidence-based guidelines for safer conception have been developed and tailored for settings in sub-Saharan Africa, including Kenya (Bekker et al, 2011; British HIV Association & Expert Advisory Group on AIDS, 2013; Loutfy et al, 2012; NASCOP, 2014; Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission, 2010; World Health Organization, 2012), HIV care providers in Kenya and throughout the region report they are not trained in safer conception methods or counseling, and HIV-affected patients are not routinely offered safer conception information or services (Crankshaw, Mindry, Munthree, Letsoalo, & Maharaj, 2014; Finocchario-Kessler et al, 2014; Goggin et al, 2014; Kawale, Mindry, Phoya, Jansen, & Hoffman, 2015; Matthews et al, 2015). Recent guidance on pre-conception care for HIV-discordant couples in Kenya outlines various safer conception strategies for HIV-discordant couples who desire children, including initiation of antiretroviral therapy at any CD4 count, viral load monitoring and suppression, limiting condomless intercourse to the ovulatory period, semen washing, and vaginal insemination timed to ovulation (NASCOP, 2014).…”

Emtonjeni—A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: Results of a Phase II Study

“…As gate-keepers of information, providers can help to ensure that clients have access to effective contraception and safer conception strategies [52]. However, numerous studies have reported that HIV providers do not routinely engage PLWH in discussions about contraception and fertility desires [35, 36, 53–61], while clients rarely initiate such discussions with providers [27, 60].…”