Contraception Counseling
Considerations
MTN-003 Study-Specific Training
Background and References
WHO Medical Eligibility Criteria for
Contraceptive Use (with 2008 update)
Family Planning: A Global Handbook
for Providers (USAID/JHSPH/WHO)
US FDA Birth Control Guide
Background and References
National family planning policies and
guidelines
National practitioner training and
continuing education requirements
Other?
Increasing Access to Contraception for
Clients with HIV: A Toolkit (FHI)
Study-Specific Background
Protocol specified eligibility criteria for
Pregnancy intentions
Willingness to use an effective contraceptive
method
Site-specific methods for verifying surgical
sterilization as part of eligibility determination
Protocol-specified contraindicated methods
Contraceptive methods available on site
Contraceptive methods available through referral
On-Site or By Referral?
Emergency Contraception
EC = back-up method for contraceptive
emergencies used within the first few days after
unprotected intercourse to prevent unwanted
pregnancy
WHO recommended regimen = 1.5 mg
levonogestrel as a single dose
Reduces risk of pregnancy by 60-90% when
used within 5 days after unprotected
intercourse (sooner = more effective)
Levonogestrel ECPs prevent ovulation, not
effective once process of implantation has begun,
will not cause abortion
Source = WHO Fact Sheet No244
Emergency Contraception
Not appropriate for regular use as an ongoing
contraceptive method due to higher method failure rate
compared to other methods
Meant to be used in situations such as no contraception
use, contraception failure, or incorrect use
Condom breakage, slippage, or incorrect use
3+ consecutive missed combined OCPs
>3 hours late for progestogen-only pill
>2 weeks late for progestogen-only injection
IUCD expulsion
Also in cases of sexual assault when the woman was
not protected by an effective contraceptive method
Source = WHO Fact Sheet No244
Contraception Counseling
As with HIV counseling, client-centered
approach should be taken to guide and
support the participant in
Making the best contraceptive method
choice for her
Maintaining adherence to an effective
method
Client-Centered Approach
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Greet client and establish rapport
Describe purpose of the session
Emphasize confidentiality of the session
Listen effectively, allow client to speak, avoid
interruptions
Communicate effectively, verbally and non-verbally
Communicate at client’s level of understanding
Use open-ended questions
Clarify misconceptions
Provide positive reinforcement
Contraceptive Counseling
There will be much information to provide
For each method
How taken or administered
Mode of action
Level of effectiveness
Possible side effects
Advantages and disadvantages
in the context of study participation
Use visual aids (methods and anatomy)
Meet participant at her current knowledge level
Dispel myths and misconceptions
Contraceptive Counseling
There will be much information to listen to
What has she heard / what does she know
about contraception and the different methods
What experiences has she had with
contraception
What factors are most important to her for when
choosing a method
Are there any partner or family issues to
consider
Contraceptive Counseling
During Screening
At Screening Part 1, Screening Part 2, and before
randomization on the day of enrollment, contraceptive
counseling is provided in the context of the study
inclusion criteria and eligibility determination
Informed consent and contraception counseling
sessions should
Explain which methods are acceptable for study
purposes AND
Emphasize that women who cannot commit to
using these methods for at least 24 months should
not enroll in the study (this is part of their
contraceptive choice)
Contraceptive Counseling
During Screening
Contraceptive counseling
All Screening Part 1, Screening Part 2,
and Enrollment
Provision of contraception (if indicated)
Per site SOP at Screening Part 1
Expected at Screening Part 2 and Enrollment
All staff should be clear on how provision of
contraception is to be handled at Screening
Part 1
Contraceptive Counseling
During Follow-Up
Continue client-centered approach each month
If participant has no issues or problems with her
chosen method, counseling sessions may be
brief but
Always provide clear instructions for use
Always reinforce key adherence messages
If participant has issues or problems
In some cases only counseling and
reassurance may be required
In other cases, consideration of method
switching may be indicated
Contraceptive Counseling
During Follow-Up
Some participants may wish to stop using
contraception during follow-up. How should
this be handled?
Contraceptive Counseling
Documentation
Record sufficient information and detail to
support review and follow-up at each visit
Use chart notes, flow sheets, and/or other
documentation tools
Chart flags/flyers are strongly recommended
to highlight key dates (e.g., next injection)
Similar flags in pharmacy system can be
very helpful
Contraceptive Counseling
Documentation
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Your Comments
and Questions