Provider initiated family planning (PIFP)

Clinical description

• Avoid unwanted pregnancies, regardless of HIV infection status.
• Use ‘dual protection’ – condoms alone are not enough for family planning as they must be

used very consistently.

• Sex without condom is risky if the infected partner’s viral load is not suppressed. Consistent

condom use is especially important in the first 6 months after starting ART and/or if viral suppression is not confirmed (e.g., low adherence and/or treatment failure).

• Some hormonal contraceptives (the pill and implants) may be less effective with ARVs or TB

treatment because of drug interactions.

• Depo-Provera® and Sayana Press® do not interact with ARVs or TB drugs but are generally

slightly less effective in preventing pregnancy than implants.

• Intrauterine device, vasectomy and tubal ligation are safe to use with ART.
• Encourage HIV positive women to make an informed choice about pregnancy. Health workers

should not actively discourage pregnancy as the risk of transmitting HIV to the baby is less than 2% if the mother:

o Starts ART as early as possible, best before conception o Is fully adherent to ART throughout pregnancy and breastfeeding Preventive services for HIV patients 47 Implementing routine PIFP in HIV clinics

• Assume that all patients aged 15 years and above are sexually active.
• Offer FP to adolescents in a non-judgmental way. Do not let personal bias impact adolescent and

young people’s access to FP services.

• Offer condoms to all men and women aged 15 years and above:

o Minimum of 30 male and/or female condoms

• Offer counselling on contraceptive methods. Refer to FP clinic if this is not feasible in the HCC

setting.

• Offer at least Depo-Provera directly in the HCC (one-stop shop)

o 1 Depo-Provera injection every 3 months

• Give patients the opportunity to refuse either method if they feel they don’t need / want it.