Integrating Counseling to Transform HIV Family Planning Services

为艾滋病毒/艾滋病感染者提供的计划生育服务侧重于预防计划外怀孕 和母婴传播（PMTCT），目前没有提供任何服务，以支持更安全的概念， 尽管撒哈拉以南非洲（SSA）约40%的艾滋病毒阳性妇女在艾滋病毒诊断后怀孕。大约一半 这些怀孕的计划，强调需要更安全的概念咨询（SCC），因为超过一半的 乌干达受艾滋病毒影响的夫妇的血清不一致，而计划外怀孕表明， 需要有效的避孕。抗逆转录病毒疗法（ART）大大降低了相关的传播风险 但许多PLHA没有接受ART或没有充分遵守;因此需要使用 更安全的受孕方法（SCM），如人工授精（MSI）和定时无保护性交 （TUI）。通过整合SCC来改造FP计划不仅对促进更安全的 怀孕，但也可能是关键，以减少意外怀孕，以及增加PMTCT吸收， 坚持和保留，因为关于生育的公开咨询促进了以下方面的知情决定： 生育，获得避孕药具，并可能限制客户感到需要脱离艾滋病毒护理时， 由于害怕与生育有关的耻辱而怀孕。利用信息技术的生态适应 动机和行为技能（eIMB）模型，我们开发并试点了一个结构化的SCC干预与42 血清学不一致的夫妇，其中33例（79%）按照指导正确使用TUI或MSI;有7例妊娠 也没有伴侣血清转化另有43对夫妇符合条件，但在最初的SCC咨询后， 并讨论了所涉及的风险和益处，决定不再继续生育，并被转诊至 避孕服务。根据初步可行性和接受的证据， 干预，并支持全面的计划生育方法，使用公开的生育咨询， 确保客户获得SCC和PMTCT或避孕服务，以实现其期望的生殖 目标，拟议的集群RCT将比较（1）一个全面的FP计划， 多组分SCC干预（SCC 1）与（2）FP护士SCC培训研讨会（SCC 2;模拟 乌干达卫生部整合新服务的方法），以及（3）现有的计划生育服务（常规护理）， 艾滋病毒诊所由乌干达艾滋病援助组织开办。3臂设计，以及计划的成本效益 分析，使我们能够研究两种模式，将SCC整合到FP服务，不同的强度水平， 从而通知卫生部政策和资源分配。60名血清不一致的患者表示， 每个研究中心将招募有生育意愿的受试者（n=540），并随访12个月，或 妊娠结束（如适用）。主要结果是使用SCM（对于那些试图 二是坚持“以人为本”，坚持“以人为本”。

Family planning (FP) services for people living HIV/AIDS (PLHA) focus on preventing unplanned pregnancies and mother-to-child-transmission (PMTCT), and currently provide no services to support safer conception, despite ~40% of HIV+ women in sub-Saharan Africa (SSA) becoming pregnant post HIV diagnosis. About half of these pregnancies are planned, highlighting the need for safer conception counseling (SCC) as over half of HIV-affected couples in Uganda are serodiscordant, while the unplanned pregnancies reveal a high unmet need for effective contraception. Antiretroviral therapy (ART) greatly reduces the transmission risks associated with childbearing, but many PLHA are either not on ART or not adequately adherent; hence the need for using safer conception methods (SCM) such as manual self-insemination (MSI) and timed unprotected intercourse (TUI). Transforming FP programs through the integration of SCC is not only important for promoting safer conception, but may also be key to reducing unwanted pregnancies, as well as increased PMTCT uptake, adherence and retention, as open consultation about childbearing promotes informed decisions regarding childbearing, access to contraceptives, and can limit clients feeling the need to disengage from HIV care when pregnant due to fear of childbearing-related stigma. Drawing on an ecological adaptation of the Information Motivation and Behavioral skills (eIMB) model, we developed and piloted a structured SCC intervention with 42 serodiscordant couples, 33 (79%) of whom correctly used TUI or MSI as instructed; there were 7 pregnancies and no partner seroconversions. An additional 43 couples were eligible but after the initial SCC consultation, and discussion of the risks and benefits involved, decided not to further pursue childbearing and were referred for contraceptive services. Building on this evidence of preliminary feasibility and acceptance of the intervention, and support for a comprehensive FP approach that uses open childbearing consultations to ensure that clients receive SCC and PMTCT, or contraception services, to achieve their desired reproductive goals, the proposed cluster RCT will compare (1) a comprehensive FP program that incorporates a structured, multi-component SCC intervention (SCC1) versus (2) an SCC training workshop for FP nurses (SCC2; mimics approach used by Ugandan MoH to integrate new services), and (3) existing FP services (usual care) at nine HIV clinics operated by TASO Uganda. The 3-arm design, together with the planned cost-effectiveness analysis, allows us to examine two models for integrating SCC into FP services that differ on level of intensity, thereby informing MoH policy and resource allocation. Sixty clients in serodiscordant relationships who express childbearing desires at recruitment will be enrolled at each site (n=540) and followed for 12 months or completion of pregnancy (if applicable). The primary outcome is use of either SCM (for those trying to conceive) or dual contraception (those who decide against pregnancy).