Task-Shifting of Couples Family Planning Counseling and LARC Promotions to Animateurs de Santé in Kigali, Rwanda Open Access
Kehoe, Emily E. (2015)
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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