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Changes in Providers’ Self-Efficacy and Intentions to Provide Safer Conception Counseling Over 24 Months

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Abstract

High rates of fertility desires, childbearing and serodiscordant partnerships among people living with HIV (PLHIV) in Uganda underscore the need to promote use of safer conception methods (SCM). Effective SCM exist but few PLHIV benefit from provider-led safer conception counseling (SCC) and comprehensive national SCC guidelines are still lacking. Providers’ self-efficacy, intentions and attitudes for SCC impact provision and should inform development of services, but there are no longitudinal studies that assess these important constructs. This study reports on changes in providers’ knowledge, attitudes, motivation and confidence to provide SCC among a 24-month observational cohort of Ugandan HIV providers. Compared to baseline, providers evidenced increased awareness of SCM, perceived greater value in providing SCC, saw all SCM but sperm washing as likely to be acceptable to clients, reported consistently high interest in and peer support for providing SCC, and perceived fewer barriers at the 24-month follow-up. Providers’ intentions for providing SCC stayed consistently high for all SCM except manual self-insemination which decreased at 24 months. Self-efficacy for providing SCC increased from baseline with the greatest improvement in providers’ confidence in advising serodiscordant couples where the man is HIV-infected. Providers consistently cite the lack of established guidelines, training, and their own reluctance to broach the issue with clients as significant barriers to providing SCC. Despite providers being more interested and open to providing SCC than ever, integration of SCC into standard HIV services has not happened. Concerted efforts are needed to address remaining barriers by establishing national SCC guidelines and implementing quality provider training.

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Acknowledgements

The authors acknowledge the important contribution of the research assistants, Mr. Jimmy Mayatsa and Mr. Christopher Tumwine, and the participants who made this study possible. This research was funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development Grant HD072633 (PI: Wagner) and R01 HD090981 (PIs: Goggin, Wagner, Wanyenze). The authors have no disclosures.

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Authors and Affiliations

  1. Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA

    Kathy Goggin, Emily A. Hurley & Vincent Staggs

  2. Schools of Medicine and Pharmacy, University of Missouri – Kansas City, Kansas City, MO, USA

    Kathy Goggin & Vincent Staggs

  3. RAND Corporation, Santa Monica, CA, USA

    Glenn J. Wagner

  4. Department of Family Medicine, University of Kansas, Medical Center, Kansas City, KS, USA

    Sarah Finocchario-Kessler

  5. Department of Obstetrics and Gynaecology, Mulago Hospital, Kampala, Uganda

    Jolly Beyeza-Kashesya

  6. Makerere University College of Health Sciences, Kampala, Uganda

    Jolly Beyeza-Kashesya

  7. Los Angeles Center for Culture and Health, University of California, Los Angeles, CA, USA

    Deborah Mindry

  8. The AIDS Support Organization, Kampala, Uganda

    Josephine Birungi

  9. Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

    Rhoda K. Wanyenze

  10. Children’s Mercy Hospital Kansas City and University of Missouri – Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Kathy Goggin

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  1. Kathy Goggin
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Correspondence to Kathy Goggin.

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Goggin, K., Hurley, E.A., Wagner, G.J. et al. Changes in Providers’ Self-Efficacy and Intentions to Provide Safer Conception Counseling Over 24 Months. AIDS Behav 22, 2895–2905 (2018). https://doi.org/10.1007/s10461-018-2049-x

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  • DOI: https://doi.org/10.1007/s10461-018-2049-x

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