Ndwiga, Charity

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Population Council Knowledge Commons HIV and AIDS Social and Behavioral Science Research (SBSR) 3-5-2020 Balanced Counseling Strategy Plus (BCS +) in family planning consultations Charity Ndwiga Population Council Follow this and additional works at: https://knowledgecommons.popcouncil.org/departments_sbsr-hiv Recommended Citation Ndwiga, Charity. 2020. "Balanced Counseling Strategy Plus (BCS +) in family planning consultations," presentation at "Advancing Integrated Family Planning/HIV Counseling with Evidence (ADVICE) Project Sharing & Consultation Event," Lusaka, Zambia, 5 March. This Presentation is brought to you for free and open access by the Population Council. BALANCED COUNSELING STRATEGY PLUS (BCS+) IN FAMILY PLANNING CONSULTATIONSCharity Ndwiga5 March 2020Population Council, KenyaOutline• What is BCS+• Why BCS+• What is different about BCS+• How does BCS+ work • Implementing the BCS+ in KenyaHistory of Balanced Counseling Strategy• 1990s: Developed and tested BCS as a practical, interactive, client-friendly strategy for improving FP counseling in Latin America• 2000s: BCS expanded to BCS+ to address HIV/STIs in FP for high HIV prevalence settings; piloted in Kenya/South Africa (2004-2007)• 2011: Revised BCS+ (2nd edition) to include 2010 WHO Medical Eligibility Criteria (MEC) and cards on cervical cancer screening, postpartum and infant health• 2015: Revised BCS+ (3rd edition) to include 2015 WHO MEC; cards on adolescents, male services, post abortion care, and women’s support and safety; and updated provider instructionsWhat is different in BCS+• Use of BCS+ simplifies decision-making • Responds to the client’s needs and reproductive intentions in FP counseling sessions• More reliable than memory and designed to minimize trial and error • Reduces the amount of recall necessary to perform a task • The BCS+ toolkit has three main job aids -the algorithm, counseling cards and brochuresThird edition of BCS+ available onlinehttps://www.popcouncil.org/research/the-balanced-counseling-strategy-plus-a-toolkit-for-family-planning-serviceALGORITHMMETHOD BROCHURESCOUNSELING CARDSBCS+ Toolkit (3rd Ed.)COUNSELING ALGORITHMAlgorithm for using BCS+Steps in using the AlgorithmPre-Choice Stage (6 steps)Method-Choice Stage (3 steps)Post-Choice Stage  (3 steps)Systematic Screening for Other Services (7 Steps)• Provider creates the conditions that help a client select FP method (Refer algorithm step 1-6)• NB: If pregnancy cannot be ruled out, the provider skips to steps 13 to 19 to discuss other relevant services the client may need• Client is given a back-up method, such as condoms, and asked to return when she has her menses1.Pre-Choice stage •More extensive information offered about the methods that have not been set aside•This helps the client select a method suited to her/his reproductive needs•(Refer algorithm step 7-9)2. Method Choice Stage• The provider uses the method brochure to give complete information about the method that client has chosen• If the client has conditions where the method is not advised or client is not satisfied with the method, the provider returns to the Method Choice Stage• (Refer algorithm step 10-12)3. Post-ChoiceStage• The provider uses information received and targets questions to determine:• Additional health services and;• Counseling that the client may need• Using the remaining counseling cards other services offered or referred:• PNC, screening for CxCa, STI/HTC, intimate partner violence • Discuss dual protection• Give return date4. Systematic Screening for Other Services Stage:COUNSELING CARDSBCS+ includes 34 counseling cards• First card asks questions to rule out pregnancy• 18 method-specific cards– Describes use, efficacy, risks of each method– Provider lays out all method cards and removes excluded methods as counseling proceeds• 15 cards on additional topics, services– HIV/STI risk assessment– Zika– Etc.Counseling cardsHIV/STI protection addressed on each method’s cardMETHOD BROCHURESMethod-specific brochures• BCS+ has brochures on 18 methods• Given to client to take homeMethod brochures (excerpt)HIV/STI protection addressed on each method brochureWorld Health Organization Medical Eligibility Criteria (“MEC”) wheel Adapting BCS+ in Kenya• Study demonstrated that BCS+ approach significantly improved the quality of integrated FP/HIV services • MoH and stakeholders adopted BCS+ in 2010 as the  standard counseling approach for FP/HIV integration• Kenya RH/HIV Integration Strategy 2011 increased scope to include PNC, CaCx, HIV care and treatment. 2nd Edition BCS+ responded to this• MOH and Integra Initiative developed mentorship guidelines for SRH/HIV service integration (used BCS+)• WHO MEC guidelines 2015, MOH with support from Pop Council and others reviewed and updated and adopted 3rd EditionReach of BCS+ Toolkit (3rd Ed.)• Available in French and Spanish• Adapted for Zika and published on the ZikaCommunication Network• Available on: – Population Council website– K4Health– Health Compass– Maternal and Child Survival Program website• An algorithm-based Interactive Voice Response (IVR) system for FP consultations tested in Kenya • Used in Ghana, Nigeria, South Africa, Swaziland, India, Myanmar, Tanzania, Mali, Indonesia  and elsewhere.ADVICE project: working towards BCS+ 4th edition• Revisit algorithm: where and how to assess HIV vulnerability?• Incorporate biomedical advancements in HIV prevention (treatment as prevention, pre-exposure prophylaxis)The Population Council conducts biomedical, social science, and publichealth research. We deliver solutions that lead to more effective policies,programs, and technologies that improve lives around the worldhttp://www.popcouncil.org for BCS Plus http://www.popcouncil.org/bcsplus

Balanced Counseling Strategy Plus (BCS +) in family planning consultations

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Balanced Counseling Strategy Plus (BCS +) in family planning consultations

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