Task-Shifting of Couples Family Planning Counseling and LARC Promotions to Animateurs de Santé in Kigali, Rwanda Open Access

Kehoe, Emily E. (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/1831ck47b?locale=en
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Abstract

Background: Projet San Francisco (PSF), a branch of the Rwanda Zambia HIV Research Group (RZHRG), has been conducting HIV research in Kigali, Rwanda since 1986. With the majority of sero-conversions occurring in heterosexual discordant couples, PSF initiated Couples Voluntary Counseling and Testing (CVCT), which has now become the standard of care in more than 90% of government clinics. PSF is now looking to combine CVCT and family planning services as a means of increasing knowledge and uptake of Long-Acting Reversible Contraceptives (LARC). This project seeks to test the feasibility of administering Couples Family Planning Counseling (CFPC) within the existing infrastructure of community health workers in Rwanda.

Project objective: To increase demand creation for LARC services through a task-shifting effort involving increased focus on training Animateurs de Santé (ADS) to administer CFPC sessions, allowing for increased time for nurse-administered LARC insertions.

Methods: Two focus groups, comprised of 6-7 Family Planning ADS each, were held at Kabuye and Butamwa clinics in Kigali, Rwanda. CFPC training materials from Zambia were adapted and revised to a level appropriate for ADS in Rwanda. Two pilot training sessions were conducted at Kabuye and Butamwa clinics and the uptake of LARC methods was monitored through an incentive-based invitation system linked to both clinics and ADS. Feedback on the pilot was obtained through focus groups and questionnaires, which was then used to update training materials and procedures.

Deliverables: Deliverables include a comprehensive training guide for CFPC and LARC promotions training for ADS. Also included are recommendations for increasing the utility of ADS-administered CFPC services and uptake of LARC among couples wishing to limit fertility or delay pregnancies. Information will be used by RZHRG to guide further studies and inform future revisions of the ADS CFPC and LARC promotions training tools.

Table of Contents

CHAPTER 1: INTRODUCTION 1

Introduction and Rationale 1

Problem Statement 1

Purpose Statement 2

Research Question 2

Objectives and Aims 2

Significance Statement 2

Definition of Terms 3

CHAPTER 2: LITERATURE REVIEW 5

Background 5

Projet San Francisco 6

Family Planning Strategic Plan 2012-2016 7

Animateurs de Santé 8

Supporting Literature 9

Ethiopia 9

Ghana 10

Uganda 10

Multi-country Review 11

CHAPTER 3: METHODOLOGY 14

Parent Study 14

NIH Grant 14

Project Site and Study Population 15

Research Design 16

Procedures and Data Collection 16

Focus Groups 17

Trainings 17

Data Analysis 18

Ethical Considerations 19

Limitations 19

CHAPTER 4: RESULTS 21

Focus Groups 21

Trainings 23

Pilot Invitation Tracking Results 25

Post-pilot Focus Group and One-on-One Questionnaire 29

Questionnaire 29

Focus Group 30

Training Revision 32

Deliverables 33

CHAPTER 5: DISCUSSION 34

Public Health Implications 34

Moving Forward 35

Conclusion 36

REFERENCES 37

APPENDICES 38

Appendix I 38

Appendix II 67

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