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Perspectives on contraceptive implant use in women living with HIV in Cape Town, South Africa: A qualitative study among primary healthcare providers and stakeholders

BMC Public Health Jul 31, 2019

Brown A, et al. - Researchers inquired primary healthcare contraceptive providers (n = 10) and HIV/contraception expert stakeholders (n = 10) in Cape Town in 2017, to gain insight into the perspectives of these people regarding South Africa’s public sector provision of contraceptive implants to women living with HIV. Also, they looked at the contraceptive service-influence of official advice against the provision of implants to women using the HIV antiretroviral drug, efavirenz, issued by the South African National Department of Health (NDoH) in 2014. They found that the implant was not provided to women living with HIV in any of the four clinics where the providers worked. Across Cape Town, the observed patterns of implant provision at primary healthcare facilities were found consistent with this, as corroborated by stakeholders. Inadequate initial and ongoing provider training; interpretation of NDoH communications regarding implant use with efavirenz; provider unwillingness to risk harming clients and concerns about professional liability; and other pressures associated with provider capacity were the factors that contributed to providers’ decisions to suspend the provision of the implant to women living with HIV. Overall, access to the full spectrum of contraceptive choices is recommended for all South African women, including those living with HIV, for which they are medically eligible.
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