Attitudes, Knowledge, and Correlates of Self-Efficacy for the Provision of Safer Conception Counseling among Ugandan HIV Providers

High rates of childbearing desires (59%) and serodiscordant partnerships (50%) among people living with HIV (PHLA) in Uganda highlight the need for safer conception counseling (SCC). Provider attitudes about counseling PLHA on the use of safer conception methods (SCM) have been explored in qualitative studies, but published quantitative investigations are scarce. 

Data from 57 Ugandan providers were collected to examine providers' attitudes about childbearing among PLHA and engagement in discussions about childbearing, as well as their knowledge, interest, self-efficacy, and intentions to provide SCC. Correlates of self-efficacy for the provision of SCC were explored to inform the development of training programs. 

Providers reported a general awareness of most SCM, especially timed unprotected intercourse (TUI); but just over half felt they knew enough to counsel clients in the future and all wanted more training. 

Childbearing was discussed with less than a third of reproductive aged patients and was mostly initiated by patients. Most providers saw value in providing SCC and believed that most aspects of SCM would be acceptable to their clients, but numerous barriers were endorsed. 

Self-efficacy was greatest among providers who had had more childbearing conversations, greater SCM awareness, perceived fewer barriers and greater intentions to counsel on TUI. Providers evidence fewer stigmatizing attitudes than in the past. However, those who endorsed more stigmatizing attitudes evidenced a trend for reporting lower self-efficacy for providing SCC. 

Training will need to simultaneously focus on increasing providers' SCC knowledge and skills while instilling a more realistic appraisal of the risks of assisting couples to employ SCM versus doing nothing.

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By:  Kathy Goggin, PhD,^1,2 Sarah Finocchario-Kessler, PhD, MPH,³ Vincent Staggs, PhD,^1,4 Mahlet Atakilt Woldetsadik, MPH,⁵ Rhoda K. Wanyenze, MBChB, MPH,⁶ Jolly Beyeza-Kashesya, MBChB, MMed Ob/Gyn,PhD,^7,8 Deborah Mindry, PhD,⁹ Sarah Khanakwa,¹⁰ and Glenn J. Wagner, PhD⁵

¹Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.

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

³Department of Family Medicine, University of Kansas Medical Center, Kansas City, Missouri.

⁴School of Medicine, University of Missouri – Kansas City, Missouri.

⁵RAND Corporation, Santa Monica, California.

⁶Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala,Uganda.

⁷Mulago Hospital Department of Obstetrics and Gynaecology, Kampala, Uganda.

⁸College of Health Sciences, Makerere University, Kampala, Uganda.

⁹University of California, Los Angeles Center for Culture and Health, Los Angeles, California.

¹⁰The AIDS Support Organization, Kampala, Uganda.

 

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