2 Minsry of Poi Heath &Satation Mis of Medea! Serine The Balanced Counseling Strategy Plus ES NN we A Toolkit for Family Planning Service Providers Working in High Come be laments Vie Population Council 2011‘© 2008, 2011 The Population Council, Ine, “The Population Council confronts eric! health and development isues facing people in the developing world. Through biomedical, socal science, and public health research, we work with our partners 1 deliver solutions that lad to more elective policies, programs, and technologies that improvelives in more than 45 countries around the work Esablished in 1952 and headquartered in New York, the Council {sa nongovemmental, nonprofit organization governed by an international board of ‘Any part of this publiation may’be photocopied without permission from the publisher provided that copies ae distnbuted without charge and tht fll source {uation is provided. The Population Council would appreciate receiving scopy of any ‘material in which the text is usd. Suggested citation: Population Couneil. 2011. Balanced Counseling Strategy las Users Guide Second Ealtion, pat of The Balanced Counsding Strategy Plus: A Tool for Fay Planning Service Providers Working High STUBIV Prevalence Settings, Second Eatin, ‘Washington, DC: Population Council Note: This publication is part of larger publication ted The Balanced Counseling Strategy Ps: A Toollat for Faraly Planning Service Froviders Working in High STH FIV Prevalence Settings, The Balanced Counseling Strtegy Plus Toolkit inciudes the following: Algor Counseling canis Method brochures User’ Guide Trainer’ aide WHO Medical Eigbiliy Criteria Wheel v v Y v any partis mising, please contac the Popul Coun st publications opsauncLaig or vst our webste at woe popcouncl rgfespus__ ae) The Balanced Counseling Strategy Pus (BCS) was fist published in English bythe Population Counc. The too! built upon the Balanced Counseling Srtegy (BCS) ‘developed by Federico Lem (Leen 1999; Leén etal. 2003a,b, Les, Veron, Mari, apd Bruc: 2008) and was adapted from the Balanced Counseling State’ A Toth or aly Plawing Service Providers, published in May 2008, Ic as been texted through ‘operations research stules in Kenya and Sout Ati: by the Population Councils USAID- funded Frontiers in Reproductive Hea Program (FEONTIERS) Cooperative Agreement IRN-A-00-98-00012-00, with additonal funding fom the Presidents Emergency Plan for AIDS Relief PEPFAR) through the USAID mission in each country. Inthis second edition, authors have maintained the sim bis format ofall he toolkits ‘components, while ising and expanding some components ad content These revisionsare based on updated new guidelines fom the World Health Organizations Medical Hligbiity Critera for Contraceptive Methods (2010) as well as recommendations {om authors and partes who have experienced and evaluated implementation ofthe tool in setngs and scenarios around the word “The updated BCS+ algorithm ines addtional ste to suppor an integrated mode of reproductive heakh service delivery, o accommodate the range of scenarios in which famly planing cents and providers discuss Sis and HIV, and to facia integrated service delivery and counseling during postpartum, postnatal, and well-chid sesies 'CS+ counseling cards and method brochures ave ben updated according tothe most recent WHO guidelines. Updated User and Trainers Guides incorpomte these adjustments and ensure consistency and comprehensibiitin training and impemenition ofthis provider tool.Porson ‘Devlopmnentof Te Balanced Counsing Strategy Pus (AS) could not have been possible “Svout the invaluable suppor ofthe sevice providers who tested the tool athe {mya directors who autherized and supersised its application. The authors wish 0 {Chak the Deparment of Health in South Africa and the vision of Reproductive Health ‘CDI and the National AIDS and STD ContolProgram(NASCOP) ofthe Minit of "Fh in Kenys, We would also ike to thank the rane atthe Wits Reproductive Heath aniHTV Insite (WRHD ofthe Unversity of Wiwaterstand for their contribution tothe ‘stu in South Aca and the providers and Provincial and Distris Health Managements “eans, Fastem and Cental provinces in Kenya for theirinptin pre-esting the second eon ofthe BCS toolkit. In partculr we would ike tothank Dr. Bashir. Nc Tsk Dr ‘Shah Kurla judith Maua, atuma Dubow, Mary Gatsits-DRH; Dr Gahan Narang ‘DANCapacity Project, Dr Nicholas Muragusi,Chisine Awour -NASCOP; Dr Jura ‘Mang, Dr George Githuka, Agnes Gichogo PHM Cental province, Dr. Anthony “Wiayoro Rosalind. Murai and Mary Maina - DEM Tai dst Peter M. Njuguna- ‘DM(T-Nyandarus-North; Dr Jcinea Nog Rose Micheni and Purity Karin PHMT= ‘Ease Provinee; Dr Leonard Okoko and Justus Mutie-DHMT Kitui dsc. ‘Deelopment and prediction of the second eition of The Balanced Counseling tatezy hs was supported by the Population Counel with inpat from Katherine Wiliams, Ssiga ‘Mick, Wilson Lamba, Manshi Menaiva, Chariowe Warren, Chay Nawigt an ta Asie: Authors would lke to acknowledge the following individuals for providing their ‘ectical expertise and invaluable corntbuions to his uplated edition ofthe BCS: Holly ‘chard, eanete Cachan, Victoria Jennings, Shawn Marcher, Nom Rutenberg, Jon “Townsend, and Eizabeth Westy.@ Contents } Introduction. ‘Why the Balanced Counseling Strategy Pls? ‘Whats included inthis toolkit? How should this totkt be used, ‘The Balanced Counseling Strategy Plu... Pre-Choice Stage Method Choice Stage Post-Choiee Stage Systematic Screening for Other Services Stage Guidelines for Adapting the Balanced Counseling Suategy Plus Job Ads. References...a "nthe late 1990s, che Population Councils USAID-funded FRONTIERS in ‘Reprodsctive Health Program (FRONTIERS) worked in collaboration with Ministries ‘of Health n several Latin American counties to develop and test a practical, ‘ncersctve and cen endly strategy fr improving counseling within fly planning consultations. This strategy is called the Balanced Counseling Strategy (BCS) (esn 1999; Leon et al. 2004). The BCS uses key job sds for counseling cen about family plsming: an algorithm to guide the prover through the caunscing proces, 8st of counseling cards for contraceptive methods, and corresponding brochures or each method. The ststegy, tested and refined in several counties, comprises users ‘of steps to determine the contraceptive method tha best suits the cen according {ohechis preferences and needs, This strategy improves the quality ofthe provides ‘counseling and allows the cent to tke ownership of the decison, ‘The BCS proved effective as. tool oasis family planing providers to improve the quality of care (Leon et al. 2003s, b,c). The approach is practical, low cost, and ‘a5) to adap to local conten. The Balanced Counseling Strategy: A Taal for Fanaly Planning Service Providers was published to provie the information and tocls needed forhealth care facity managets, superiors, and service providers to implemen the 'BCS in thei family planning services (Leen, Vernon, Martin, and Brace 2008) Why the Balanced Counseling Strategy Plus? 'n response tothe need to incorporate counseling, screening, and services for sexually tansmited infections (TI), including HIV, within routine family planing consulations in etings characterized by high prevalence of thes infections the BCS ‘was revised to imtegrate STUAIIV prevention courseling, risk sessment, and HIV ‘counseling and testing (HT). The resulting Balanced Counseling Strategy Plus (BCS«) ‘ool improves the quality ofthe family planning service and enables providers to sddress clients’ needs telated to STIs and HIV dating the same consaltvion Integration of health services has been defined as fering ange of services that can ‘nec several needs simultaneously, usually in the same venue and through the sane Provider. Referral to, or linkages with elated services enable a cient to recive a fangs of needed services even ifthe services are not recived simlanously (Askew 2007). tn reproductive health the push for iteration or inkageis guided both by many lens having the need for several servis imulkaneuly and 2 med ‘portunities canbe reduced) and by the expectation that he comporene eres, an be provide more efciently when integrated or linked then when dlivesed ‘dividual. Despite many cals for greater avention to integrating such services in igh STUAIV stings, surprisingly ite attention has been paid to the development snd empirical iesing of practical oolethet- prov rege Te ‘pacity to offer integrated services, ‘he FRONTIERS program developed and piloted ihe BCS. in Kenya (2005 to 907) and South Africa (2004 to 2006) because bath countries have high rates of‘ls, cluding HIV, and their contraceptive prevalence rates ae relatively high for the region, Ths situation provides opportunities to reach a substall proportion ‘ofthe sexually active population (albeit predominantly female) thats seeking to prevent pregnancy and tha also may be at risk of exposure to an STU/HIV. As in most ‘ouriries, ther family planning and STUHIV programs ae implemented seperately, although both counties are actively seeking ways to integrate services. Ths, both Ministries of Health were keen to develop practical cos for increasing the quality of services and numbers of clients receiving integrated services. The study findings are descbed more fully elsewhere (See Liambila etal. 2008, Mullick etal. 2008). Both stulies showed that Integrating STVIV prevention counseling ané rk asessment with offering LCT during family planning consultations is feasble and acceprableto cients and providers. ‘+The quality of care for both family planning ard STVAIV counseling improved significantly with the use ofthe BCS+ tls Counseling on FCT increased substantially. In Kenya, more than 40 percent of clients wee olfered HCT services, with almost half ofthese deciding to be tested, either onsite or through refeel. In South Afric, those oflered ‘esting increased to 29 percent. Furthermore an overall increas in esting was observed inthe district with « doubling of ind viduals tested Use ofthe BCS tools facilitated greater sk asessment for STIs and HIV. ‘Also, decisions about contraceptive method coice were made with a better ‘understanding of thet relationship to ifetien prevention. ‘Despite the concern that adding these services may have a negative impact on ‘the family planning service, improved quality af counseling and no evidence of decline n-wliztion showed that this conce'n was unfounded. icluded in this toolkit? ‘The BCS job aids and guides are intended for reproductive health programs ‘interested in both suengthening the quality of family planning counseling and responding to the addtional service and counseling needs of clients. n addition to adding further guidance on other integrated services, the second edition has incorporated an additional ob aid, the World Health Organization’ Medical Elgbilty Criteria Wheel, to complement existing provider took and facitate comprehensive family planning service provision. Below sallis of xe toolkit components: What 1, BCS+ User’ Gulde (this document) on how to implement the BCS, It expains how to use the job ads and canbe distributed during raining onthe BCS+ or used for self-teaching with the BCS+ job aids. 2. BCS+ job aids, including ‘The BCS+ algorithm that summarizes the 19 steps recommended forthe ‘implement ion ofthe BCS+ during a family planning consultation. These steps ae organized under four stages ofthe consultation: pre-choice needs assessment; method choice; post-choice actions, and systematic seeening for other services, During each stage ofthe consultation, the provider is given step- by.step guidance on how to use the BCS+jobalds. Depending onthe clients response tothe issues discussed, te algorithm outlines which actions o take.“The BCS+ algorithm can be found on pages 1010 12 inthis document aswell 4 separately with the other job aid in the tool. + Counseling cards that the provider uses during counseling session. There are 26 counseling card, The fist card contain 6 questions thatthe sevice provider asks to rule out whether clients pregeant (adopted rom those developed by Stanback eal, 1999). There are 16 method:-specitic cards that contain information about each fail planning method. Each method card hha am ilostration ofthe contraceptive mod onthe front side. The back of ‘he card contains list of5 co 7 ey features ofthe method and describes the ‘metho effectiveness, These card ate used to fst exlude those methods that are inappropriate for the clients reproductive intentions and then to narrow the choice to reach a final decision. Nine counseling cards provide ‘information of additonal counseling and services that a family planing cient ‘may need, These include: healthy timing and spocing of pregnancies; healthy ‘posipartum period for the mother, promoting newbom and infant health; STV HIV transmission and prevention; STUHIV rik assessment; dual protection; HI counseling and testing; positive health, digit, and prevention; and ‘cervical cancer screening, These cards ae used during the fourth sige ofthe ‘consultation systematic sereenng for other services. + Method brachures on eich ofthe 16 contraceptive methods. They are designed to help the client better understand the method chosen. The provider fives the cient the brochure forthe selected method and a brochure with ‘information on condoms to take home. Provides should encourage low-iteate oriliterate clients to take the brochure home sothat thelr partner ot other ‘usted friend can review the brochure with them again + WHO Medical Eligibility Criteria (MEC) Wheel sa provider job sid based on the four eligibility categories for contrsceptive use in relation to ‘medical conditions desribed inthe document Medical Fligbity Criteria for ‘antrceptive use, Fourth edison, published by Bepartment of Reproductive Health, World Health Organization. This tol guides providers through medical conditions and medications that may be contaidcations to use of particular contraceptive methods. The job aid has been feld-tested in three countries by WHO, and is found tobe very useful to providers who use it 3. BCS+ Trainers Guide that supervisor sand others can use to train providers on hove touse the BCS, The guide includes exerlses and activites to increase participants comprehension and proper utilization ofthe BCS+ tol, “The BCS+ job ads and BCS+ User’ Guide incorporate the latest iteration faily planning and STUIV norms and guidance as recommended by the World Health ‘Organization (WHO), including Medical Eibiliy Crea for Contraceptive Use (WHO 20108), Family Planing: Global Handbook for Provides (WHO/RHR and JHU CCR, INFO Frojct 2007), Contraceptive Tecnology (Patcher etal. 200%), Selly “Transmitted and Other Reproductive Tract Infection: A Guide wo Essential Practice CHO 2005), andl Guidelines forthe Management of Sexually Transmitted Injections (WHO 2003),“These job aids canbe revised depending on national and/or regional guidelines and protocols, Guidelines fr adapting the BCS Job ald are included in this document Electronic copes ofthe BCS» materials are available so thatthe job aids and instructional guides canbe ely printed of adapte to meet loal needs. How should this toolkit be used? 1, Read this entire BCS+ User Guide on how to implement the Balanced Counseling Suategy Phos. 2, Refer tothe BCS+ algorithm a reminder ofthe 19 steps used to implement the BCS. It is helpful to havea copy avaiable onthe providers desk or on a wal in the consultation area so that the provider can refer to it easly 3, Use the BCS+ counseling cards and WHO MEC Wheel hep client choose a ‘method based om her/his reproductive intentions. Use the fist counseling card to rule out whether the lint s pregnant. If she isnot, use the method card 0 hep the cient choose a contraceptive method best suited to bev/is reproductive heath intentions by discarding those that ae inappropriate. Emphasize dual protection throughout the counseling. 4. Once the cient has chosen a contraceptive method, use the coresponding BCS+ ‘method brochure o discuss containdicationsto the chosen method, there ae none, review the rest ofthe brochure withthe client to reinfore information| boat the method chosen and to respond to questions. This helps to ensure that the client understands the method. ive the brochure tothe client, Ste can refer tot at home or use to tlle wo hers partner. 5. Use the counseling cards to discuss additional reproductive bealth serves that a family planning client may need duringand after clients have selected ‘contraceptive method. These inchide counseling on healthy timing and spacing of pregnancy, postpartum health forthe mother and infant, cervical cancer screening, STVHIV tansmisson and prevention, conducting a risk assessment, defining dual protection, discussing and oflerng HIV counseling and testing 6, Fortrsiners, use the BCS Trainers Guide to faire healthcare staff with this rnew counseling approach and to build their expacty to flectvey use the BCS ‘The exercises in the trainers guide can be given all together in a workshop and/ or wed separately during stalf metings or onte-job taining during supervisory 1. The BCS+ jobads, BCS Users Gude, and BCS+ Trainers Gude ae aril seeconic files, dae these materials for use in your repon 3" coun as neded@n. Balanced Counseling Strategy Plus “The BCS+ is divided into four counseling stages. Fach stage contains a sequence of steps to follow. The BCS+ assumes thatthe mative ofa cent’ vist s family planning Dut seresto also ofer the lent addtional counst ing and services in the sme fcity ‘or through referral, The BCS+ integrates pospartum counseling messages o ensure health ofthe mother and the infart, an opportunity to discuss healthy ing and spacing of pregnancies, s wel as counseling on STVIIV transmission and prevetion. Information onthe ears instructs provides through conducting an STUN risk assessment, discusing dual protection and postive hal, and discussing and ofering the cient HIV counseling and testing, The BCS+ proces can be summarized a a decision-making algerithm, which is described on he next thre pages. Below is 8 summary ofthe four counseling stages + Pre-Choice Stage: During his stage, the provider creates the conditions that help a client select a family planning methed. The provider cordially greets, the client. The provider emphasizes to the cient that, during the consultation, other reproductive health issues willbe addvessed depending on her/his individual circumstance. The provide reviews the client’ ety intentions znd counsels her/him on healthy timing ané spacing of pregnancy. Pregnancy ‘s ruled ou using the counseling card with the checklist of questions. the client isnot pregnant, the provider dsplaysall the method cards and asks ‘questions described in the algorithm. As the client responds to each question, the provider sets aside the cards ofthe methods that are not appropriate forthe client. Setting aside these cards helps to avod giving information on methods "hat ae not elevant to the client’ needs pregnancy cannot be ruled out, the provider skips to steps 13 to 19 0 discuss other relevant services the client may need. The cent is given a back-up. ‘method, such a condoms, and asked to retam when she has her menstruation. Method Choice Stage: During this sage, te provider offers more extense information about the methods that have nzt been set aside, inching thelr effectiveness. This helps the client selec method suited to herhis reproductive needs, Following the steps in the BCS+ algorithm, the provider continues to narrow down the numberof counseling method cards until method is chosen, + Post-Choice Stage: During tis sage, the provider use the method brochure - to give the client complete information about the method that fhe hae chosen the client has conditions where the method snot advised oti not stisied with the method, the provider returns tothe Method Choice Stage to help the client select another method. The provider ls encourages the client to involve her/his parne( in decisions about contraception, ether through discussion oF eT Systematic Screening for Other Services Stage: During this sage, the Drovider uses information collected previously and targeted questions to{determine additional heath services and counseling thatthe family planning client may need. Using the remaining counseling cards, the provider may revlew important information fora pestparam mother or infant; may refer him/her to well-child services; discuss and offer cervical sereening test discuss STVAIV transmission and prevention; conduct arisk assessment; discuss dual protection and positive health; and offer the cliem HIV counseling and testing ‘The provider offers HV testing to chen, following national protocols, and encourages the clint ta disclose her/his STUHIV tatu co hevfis partner), Jetting the client know both the benefits and risk of disclosure. Upon completion ofthe counseling session, the provider gives fllow-upinsiructions ‘on the chosen contraceptive method, the method brochure, and a condom ‘brochure, The provider and clent aso fix a date for a follow-up vstAlgorith nfor Using the Balanced Counseling Strategy Plus Second E éion Chace Stage 1 tablish and mainain warm, cordial relationship, 2 Inform cient that chee willbe an opportunity to addres other health needs aier family planning needs are addressed 1 Ask client about curent family size, desire to have more children, an d current ‘oniracepie practices. Counsel the client on Hzalhy Timing and Spacing of Pregnancy using counseling card a) if ciene is currently using a family planning method, ask about Therfis| satisfction with it and interest in continuing or changing the method Rule out pregnancy using he checklist to be reaonably sue a woma nis not pemant [Vid you havea baby less tan IONo'toalloftie 6 months ago? Iso, are yo ‘questions, fly beastie? Have you hal no menstrual bleding 1. Pregnancy cannot be sine giving inh? eves" wamy ot | ruled out [Dotter yousbsained ron] these questions, | 2. Give client pregnancy F Hmmm | eens [2 ie | taemensaal Bessie signs and avaiable, or reer her [seed smpomsof | toananenaul elise prea, | 3. Ate hero rum 5, Have you gven bh i the as las 4 weks? LPregnaneyis | menstrual bleeding [fDi yours mensrval uel 4. Provide her with Dleing art wathin the past back-up method sich, 7 cays (or within 12 days | 2. Continue to as condoms, tose you punt sean TOD) step 3 vu then 5. Have you hada misearcage oF 3. Gov Susp 13 abortion inthe past 7 days? (5. Have you been usinga reliable contraceptive method ‘consistently and cconeetly? 4.__Display all ofthe methed cards. Ask client if she/he-wants # particular method, {Askall ofthe folowing questions. Set aside method cards based on the ‘clients responses. 4)Do you wish to have children inthe future? Tes, set aside vasectomy and tubal ligatan cards, Explain why. II-No," keep all earals and continue') Have you given birth in the last 48 hour? IE -Yes," st aside combined oral contracepves (he Pl), combined injectabes, implants, and taba gation. "No, continue with next question «Are you breastfeeding an infant les than 6 months old? ‘Yes set aside the combined oral conrsceptives (the Pil) and combined Injectable card. Explain why. "No" or she has begun her monthly bleeding again, set aside the acational smenorthea (LAM) card. Explain why. 4) Does your partner support you in family planning? . Yes" continue with the next question. No,” st aside the following cards female condom, male condom, Standard Days Method®, TwoDay Method© and withdrawal, Explain why. ‘© Do you have any medical conditions? Are you taking any medications? Yes” ask farther about which conditions or medications. Refer to WHO Medical Elgbilty Criteria Wheel or current rational guidelines and set aside all contraindicated method cards. Explain why | IE-Noy" keep al the cards and continue. 1) Are there any methods that you do not want 19 use or have not tolerated inthe past? If-Yes," set aide the cards the client doesnot want. -No” kep the rest ofthe cards | Method Choice Stage 7. Briefly review the methods that have not been set aside and indicate their ceffetiveness. I 2) Arrange the remaining cards inorder of effectiveness (number on back of each card) 1) In onder of effectiveness (lowest numter to highes),briely review the rsbutes on each methed card 18. Ask the client to choose the method that is most convenient for her/him, 9. Using the method specific brochure, check whether the client has any “ “ © 3. eer mths cich asthe UD, apn sal ston or vib ate never seed at your heath care faci sil let the cen abou these methods, and provide neler wo anoter faci ceted, 5Method Choice Stage ‘Stop 7. Briefly review the methods that have not been set ase and indicate their effectiveness. 4. Arrange the remaining method cards that have nct been set aside on your desk or table according to their level of eectiveness. Se Figure 2 below, Figure 2. Method cards arranged according to effectiveness 2. Display them with the lowest numbers fst andthe highest numbers las. (The ‘numbers on the bottom left-hand side ofthe bac ofthe card, This number Indicates the efeciveness ofthe method.) 3, Explain the effectiveness ofthe methods, fectiveness i measured asthe number of pregnancies among 100 women inthe fist yea" of use. The lower the number, the more elective the method and the fewer women get pregnant using the ‘method. See Figure 3 for example.1c et pe “Tmcapes + oem cea ec : re" “ shrew ee eter estan apt ra an eta vr sim tcai opener “Regi wth be card wih the lowes umber ead the 5 to 7 key etures ofeach atrbe miaton the carts spayed Yau maya atk he chen sa ee stuributes hechhimsell Expl (Grate and eles the only method that provides dual proveston aginst pregnancy and STs, including HIV Emphedas following MM Sts orsiasitismdcorrete raha merck Percent Ceeeen of HIV ransmision hat woul have occured withos conde, © Gondoms reduce the rskof becoming need with many Tle wben soe ‘consistently and coretly= Protect best against spread of STIsby discharge, such as HIV, gonorrhea and chlamydia ~ Also protect aginst spread of STisfrom skin-to-skin contact, suchas herpes and human papillomavirus (HPV). ‘Step 8. Ask the client to choose the method that is mast convenient for her/him, 1, Ask the client whether sf has any questions or comments about the methods discussed. Respond to any questions. Resolve any doubts before proceeding 2 _Askcthe client to choose method that is mest convenient for hea. 3. Ifthe client asks that you choose the metho, expan that s/he ithe only person ‘who knows her/his needs. You may give recommendations about a method, but allow the cient to make the fital choice. 4. Once the client selects a method, do not take the remaining method cards off the table. You may need 1 return to them ifthemethod chosen is not advised o the client changes her/his mind, 5. Ihe cient doesnot like any ofthe methods discussed or cannot make up hes? his mind, give the client a back-up method, such as condoms, rouse unt she ‘decides on a method of choice. Condoms can provide dul protection agains pregnancy and STIs until the client has another or an addtional method. Goto Step 13, ‘Step 9. Using the method-specific brochure, check whether the client has any conditions for wich the method is not advised. 1. Selec the BCS+ method specific brochure curesponding tothe method chosen by the client. 2. Together with the ciem, review the section entitled, “Method not advised if you.” inthe method brochure. This lists conditions when the method isnot advisedMeth [Fen ‘example, forthe Pil od na advised f you: Are breasteeding an infant Jess than 6 months old, ‘Smoke cigarettes an are 35 ears old oredr Have high blood pressure, 14090 ot higher, Hive certain uncommon serous dszasts ofthe heart or blood vessel ‘Dscuss with your provider. Have severe liver conditions. Have blood clots, deep vein thrombess, or pulmonary embolism, or are on amicougulantcerapy Discuss with your provider Hive lupus Have gl blader diese, even if milly treated, Discus wih your provider, Hare breast cancer ora hisory of breast cancer Have migraine headaches (severe headache that doesnot go away with Pancetamol and ae 35 years old or older. Have migraine aura (sometimes seg. growing bright sptin one eye) Take medicine for seizures or tke rifmpicin, ‘Take ntonavirsoosted protease inhibitors span of HAART, 3. _Using simple, clear language, ask probing questions to make sure that te client «doesnot have any conditions for which the method i not advised ‘Based on the clients response, decide whether o provide the method or tum to ind) ss no conditions Golo sep as any condition as any conlton and reached this sep| 1) Explain te need to choose anlher ‘tom Step 5aeady had the methods. | "mato ns 1 Explain the ned a choos anther ‘method 2) Return Step 7 2 Rew eSPost-Choice Stage Stop 10. Discuss the method chosen with the client, using the methed brochure 88 2 counseling too. Determine client's comprehension and reinforce key formation 1 Use the method brochure as a counseling tol t review ll the information shout the method chosen by the lent. Begin by saying something lik, "Mrs Mr (Game), his brackare for you take home, Beer you go, {woul ike orev che, information with yeu.” 2. Using clear, simple language review the information about the method presented inthe brochure: ‘+ General information (Thisis the same information as on each BCS+ method card) How the method works Important faes about the method ‘When the method is not advised Side effets Health benefits (if pplicable) How to use Follow-up (i applicable) ‘When to return to the heath cate fcilsy 3. Make sure the client fully understands all specs ofthe method sfhe has chosen, Comprehension is key to healthy elective use ofthe method. ‘4. Give the client the brochure, Encourage herhim to review the brochure again at Fhome and when sfte needs to remember anythirg about the method, 5. Validate comprehension by asking the client to answer the following questions in hhe/his own words. (Ste may refer tothe brochure ) * How do you use the method you have chosen? "What side effects might you experience withthe method? {Can the method protect you against getting in ST, including HIV? ‘What are the signs indicating when you should return tothe heath care foaliy? 6. Assure the client hat tis fine fhe cannot remember all the deals, Make sure the cient can find the information inthe brochure. (Note: Ifthe client cannot read or has very low literacy sil sk the lent io identify a person at home ‘who can read the information to herthim ) 7 fthe client selects a method not avaiable on sit, then 8) Sil give client the brochure forthe method chosen, Dy Refer the client oa facility or commercial outlet where sf can obtain the method, © Provide cient with an alternative, suitable method until s/he can obtain the ‘method of choice,8 tbe client selects a rethed thts temporarily unavalable out of scl, the 4) Give the client a rochure forthe methoc chosen 2) Refer the chem ta facility or commer outlet where she ccan obtain the method. «© Provide lent wits a back-up method unil sfhecan bain thee method of choice. 4) Askihe lent roetum when the methoc isin soe at your health cae faci. ‘Step 11. Make sure the client has made a definite detision Give br erfhim the ‘method chosen andor a referral, and back-up method. depending on the method ‘selected. 1 Ask he cen iene herhis choice is definite. Mate sure She is happy with the choice of method, the lon De tis Happy with the metiod |1) Give hevhin the wathod and brochure chosen | 2)_IETUD, implan, ruta gation, oF vasectomy is chosen and not avaiable on site, give arte for the procedure, needed, 3) Ifthe client cannot immediately use the chosen method, provide a back-up method Gg. condoms), Gie the BCS» brochure on condoms, 4) Suggest that he may aio abstain. from sex until se obains the methed of hoe Not happy withthe 1) Assure the clen tha iis fine 1 change he ‘method chosen andl his mind, The cienchas right informed wishes to consider otter | choice options 2)_Return to Step 7 2 Donor le the clint eae empy-handed. Ifa methods not rable, make sre the cient asa bak-up method (eg, condoms).a eer, an ie eS brochure on condoms 3. Give the lent hidher method brochute. ‘Stop 42 Encourage the cit toavolve patho a disions about practice of contraception though dscussion ora vist tothe clini, |. Encourage dhe cent odes hers once method vith hers panner Wenn Ta scan hep nthe allowing manner * Your purer can remind you ofthe time wo take your method, taking method regularly, and follow-up dates a8 Ifthe client selects a method thats temporarily unavailable (ott of stock), then 4) Give the client a brochure forthe method chosen, ') Refer the cient to a facility or commer outlet where sfc can obtain the method, © Provide cient with a back-up method until the can obtain the method of| choice 4) Aske the cient to etum when the method i in stock st your health care fall ‘Step 11. Make sure the client has made a definite decision, Give her/him the ‘method chosen andlor @ referral, and back-up method, depending on the method selected. 1. Askthe client whether her/his choice i definite, Make sure seis happy withthe choice of method, Whe eit De this Happy with the method |1) Give hevhin the method and brochure, chosen 2) IUD, impiant, cabal ligation, or vasectomy is chosen and not available onsite, give areferal for the procedure, ifneeded 3) Hfthe cient anne immediately use the chosen method, provide a back-up method (eg. condoms). Give the BCS+ brochure on condoms 9) Suggest that fhe may also abstain from sex ntl se obtains the method of choice ‘Not happy withthe |) Assure the cient that tis fine to change hea ‘method chosen and his mind. The client has right to informed Wishes to consider other | choice options 2) Return to Step 7. 2 Donotlet the client lave empty-handed. fa method is not available, make sure the cient has a back-up method (eg, condoms), refer, and ihe BCS brochure on condoms. 3. Give the client hither method brochure, ‘Step 12. Enesurage the clint to involve partners) in decisis of contraception through discussion or a visit tothe clinic, 8 about) practi 1. Encourage the clint to discuss hevhis contraceptive method with hess partner 2. Mention that his can help inthe following marner * Your parnercan remind you ofthe time take your method, takinga ‘method regulary and follow-up dats, a{You can negotiate condom us o prevent ST, including HIV. * Youcan discuss your plans to ave chien, regards of whether you are HIV postive or negative * Youcan discus and help prevent mother o child transmission (EMTCT) of HIV doring pregnancy. * Your partner can support you if you need wellness and HIV services, including anizetrovtral therapy. Use the eight (8) counseling cards to discuss additonal information and provide ‘adional counseling and services thet the client may need, ‘Step 13. Using information collected previously, determine elient’s need for Postpartum, newborn, and infant care or welLehild services, 1} Consider information that the cent has provided previously ding the ‘cunscling esion, including hes responses o questions in Step and Sep 4, 2 informacion was not revealed through previous questions, ask client the fallowing wo questions Have you given birth recently? * Do you ave any children les than 5 year f age? 3. Use this information to determine whether the cient needs adltonsl infomation and counseling on postpartum, newborn, and infant cae ora releral for well-child services. the cent as: De this Given bith recently | 1) "Review Promoting a Healy Postpartum Period foc the Mother counseling card with cient. 2) Review Newborn and Infant Health counseling card with cen CCildeen tes than 51) ~Askif children have been ken w welled years of age sence, 2) Ask i children have received all mmunizations, 3) Ask f children have had thet height and weight isn have had ther height and 4) Refer. well-chil services if needed, ‘+ Went tas given in rece (within the pas.6 weeks), review the points below fom the Promoting a Healthy osiparun, Peed counseling Prone SCT COUSTing and sevice: * Ensure chat the mother has support forthe ist few days after bin; encourage ret and sleep. * Recommend a nutritious det forthe mother that includes plenty of fuids and micronotiients (including Vitamin A ad ion).Gauss normal postpartum bleeding and lochs. Counsel on maternal a 10 6 weeks, and 4 10.6 months, ~ als on maintaining personal hygiene, including cr of perineum and breasts "Counsel on ream to sexual activi, which should be whenever the ther feels ready and usually afer lochia stops. Advice hn ch con Garage posal depreson, which may ental crying ex ling eet oF rable lcking motivator having cifteatydepine "ejecting the baby, % Mite clent has gven bit receny review the pins below rom the Promoting Newhom and Infant Health counseling ard and provide teareced counseling alate etl and washing prevent infecton piri handingthe aby and afer changing diapers, Gpunsel the mother on newbom dager sgn and when ose are reat hve reaseding fe 6 months. Nothing ee i neces Peery att Introduce complementary foods at 6 montis sad conten io breastfed, "For infants exposed to HI; ~ Advis mother to give infant ani-etrovinl drugs (ARVs) daily ‘ile breastfeeding and comine for one week ater cesator of breading (around one yea) and advise mother tocentene ARV er national protocol Recommend thit HIV-exposed infants be tested for HV at 6 weeks and start co-trimoxazole prophylaxis (CT3), = Link mother and infant to HIV dine “Rapin immunisation schedule for ints sing national or bal ‘iidelines, and include recommendation for Viamin A at 6 or he * Prac the need to attend child-wellwe clini andthe pores of Mie a8 timely care and monitoring during the is five yea of seis ‘Me. The following services may be included in well child em ~ Immunizations Growth monitoring ~ nf feeding suppor = Wtamin provision a6 months © Gekchld services Gncluding Inegrted Managemen of Chldhod tess cn) et abl coun or provide services, ree em the pproprte facilty 0 "eceve this information and counseling 2B‘Step 14. Ask client when she had her last screening for cervical cancer (VIA) VILI or pap smes 1 ‘Step 15. Discuss STIHIV transmission & prevention a the Briefly inform the cient sbout cervical cancer. Explain that cervical cancer: * Results fom uncontrolled, untreated growth of abnormal cells in he oervix ‘Js caused by asexually ransmitted infectior, the human papilomavires Hv) + Takes 10 0 20 years to develop, so thet is long period of oppomunity to detect and treat changes and growths before they cause cancer Explain tothe client that sereening for cervical cancer "Helps to detect any changes and precancerous growths before they become 1 Issimple, quick, and generally not painfl ‘Ask lent when she had her last seeening for cervical cancer. athe clint: Do this: ad erat sceeing | Provide Pp smear o AVL scening es trorethan3 yer | Or |" | Refer for Pap smear or VIAN scening ea | =oe=——} spproprat lacy when es sala Does nat ow when teva screening Ws iad er last seeening | Advise cient when to seek next screening Tess than 3 years ago "Ifelentis HIV postive then ask I er sreening was more han 6 monilSTo one year ago (according to National Guidelines) ‘dual protection with t using the counseling card, Offer condoms and instruct her/him in correct and consistent use. 1 ‘Explain tothe cient that if s/he is having unprotected sex, s/he i at risk for geting an ST, including HIV. Review the fllowing poins rom the counseling card and assess the clients knowledge of STUIV. * A person can become infected with STi, induding HIV, through unsafe or unprotected sexual activity 4 STisare common: - ~ ‘+ Aperson living with STIs (including HIV) may have no symptoms, may look hnalthy, and may not be aware that shee infected, + Common STI symptoms include vaginal discharge, discharge from the penis, sores in the genial aea, burning on urination far men, lower abdominal a 1 ‘Some STIs can be treated. To avoid re-infecton, both partners must be treated. Risk of infection can be reduced by using a ale or female condom, limiting the number of sex parners, and delaying sex (adolescent) ‘HIV is a sexully transmitted infection, IV's transmitted through an‘exchange of bodily fluids such as semen, blood, breastmilk and during delivery. Knowing your HIV status protects you, your partner, and your family. * Although HIV cannot be cured, erly entiation and treatment ca allow | ‘person to livealong, productive lif and prevent his/her partner fom ‘becoming infected, ‘+ Male circumcision reduces the risk of ecersenualy acquired HIV ‘infection in men by approximately 60% and should be one element of a comprehensive HIV-prevention package. ‘Maternal transmission of HIV to the child can be substantially reduced by denying women living with HIV and providing treatment or prophylactic ARV medicines during pregnancy, 3. Ask whether the client has any questions. 4. Explain tothe cen that dual protectin i the simultaneous prevention of STs and pregnancy. 5. Using the counseling card, review dual protection strategies with the client * Dual protection isthe use of condoms consitenty and correct in combination with another family planning method. This provides added protection aguinst pregnancy incase of condom failure. * Use a male o female oncom correctly and consistently with every act of sex. This one method protects against STIs and pregnancy Engage ony in safer sexual inimacy that prevents semen and vaginal Quids| from coming in contact with each others genitals or other vulnerable ates, suchas the mouth and anus '+ Delay oravoid sexual activity especially witha pares whose STU status snot known, 6. Ask whether the client has any questions. 7. Offer condoms. Ask whether the client knows how to wse a condom, 8. Demonstrate use ofthe condom, if required. Askihe client to do a repeat demonstration 9. Provide information about where the client can obtain condoms. ‘Stop 16. Conduct STI and HIV risk assessment usieg the counseling card. I symptoms are identified, treat her/him syndromical 1, _Askewhether the client knows what puts heafis at risk ft STIVEIV. 2. Comect misinformation, illin gaps, and answer any questions. 3. Using the counseling card, discuss the following rsk assessment factors with the client ‘+ HIV sus and HIV status of partners). If pares postive, whether She is taking ARV medicines [Number of sexual partners, both curren andi the past, Knowiedge of partners sexual practices and pest partners, * Knowiedge of male panner® circumelsion sas 8‘Past and present condom use (including pereption of pane’ atta) and whether s/he is aware that condoms pretect against both STIHIV and pregnancy 1 Type of sex or sexual activities and behaviors (fr example, mutual ‘monogamy, whether partner has oer sexual parners, oral sex,anal sex, dry sex, er use of detergents and/or spermicide). Homelife situation lor example, pare violence and social suppor Use of PMTCT services during pregnancy. delivery and breastfeeding, Ifthe client has ST symptoms, either teat hevhim syndromically per national guidelines or refer her/him for tests, i evalabl 4 Help lent makes plan to reduce ek Stages may cide Reducing the numberof sexual partners Using condoms (male or female) cortecly and consistently with every act of ‘ex, Condoms are the only method that proxcts against STIs, including HI. Making condoms avalable to herfis parmer and encourage their use correctly and consistent * Avoiding the use of unclean skin-cuting instraments and/or injection needles ‘Having any ST or cervical infection detected and treated immediately Undergoing any procedures involving the genital tract in an aseptic Practicing dul protection. Knowing your HIV stats, Step 17. Ask client whether shefhe knows herhhis HIV status, 1, Askelient whether she knows her/his HIV stus 2. Gently inquire whether the clients willing to tell you hers satus 5. Inform the lent chat yu wall not share eri status without consent, the eient Do this ‘Knows HIV sazus | 1) Review Postve Health, Dignity, & Prevention and isliving with | counseling card with chen HV 2) Aske when the clit last attended a health facility for herhis monitoring vst 3) Refer client to center for wellness care and ‘neatment, necessary. Knows HIV status | 1) Discuss melrame for repeat esting ‘Does not know het? | 1) Discuss HIV Counseling and Testing (HCD with his status lient, using counseling card 2) Offeror iniate HIV testing, according to nations 3) Counsel client or the test results. 4) Ifelen Is ving with HIV, review Postave Health, Dignity, & Prevention counseling card and reler lien 19 centr for wellness care an treatment.client knows her/his HIV status and is living with HIV: b, Review the following points from the Positive Health, Dignity, & Prevention card with len: * People living with HIV should always use a condom correctly and consistently with their sexual partners, ‘fa woman with HIV wants to get pregnant, the risk of her passing HIV to her newborn may be greatly reduced by taking antiretroviral (ARV) ‘medicines and having a safe delivery. tis important to receive cae at an antenatal cae cline and an HIV treatment center * People living with HIV need regular health checkups to see if they need ARV ‘medicine to evaluate how they are doing on ARV medicines, and o rule out other infetions or illnesses. Ielient staking ARV medicine, sth should atend follow-up clinic visits sas recommended by the provider. Vists may be more frequent when ARV medicines ae inated, ‘The cient should do her/his best to adhere tothe medication regimen prescribed and should not share medications, ‘Partners should gt tested as wel, The client can bring hevhis partner i for ‘counseling to talk together, this wil ep, * tfeurrently taking medications for ruberalosis, ste should follow up with provider, Positive health results from taking care of oneself and being alert to health ‘oncems that watrant attention, which may include physical and mental health issues as wel as social support. Provide support and counseling to client on sues around disclosure of HIV status, Encourage client o disclose her/his status to help them, * Get suppor from client spouse, family and health center, * Beer plan and make appropriate decisions about HIV care and support and family mates 1 Geveatly acess to medicine and suppor tht keeps cient healthy. 1 Save an HIV-negative partners and unbo chil ile by not nfetng them, ‘+ Beter negotiate condom use with client partner to prevent them hes being infected Avoid exposure to repeated infections that will compromise client’ health. Ask when the client last attended a ealth facily for heefhis monitoring vist. Encourage client o follow all health and wells recommendations. 4. Refer client to center for wellness care and tretment itknows herfhis status and is Discuss timefame for HIV retesting, Consider len and risk asessment and ‘sexual behaviors to decide the most appropriate frequency fr HIV vesting, Refer to national guidelines and protocol to determine the appropriate timeframe and recommendations for HIV retesting Emphasize to the client that prevention, early detection, and prompt management of STs, including HIV, are beneficial wo heh, their partner and family, and the ‘community at large. aient does not know herfhis HIV status: ‘Using the HIV Counseling and Testing card, discuss the following points withthe client: * Knowing your HIV status can help you make decisions abou protecting yourself and your semual partner) ‘Testing permits people living with HIV to ste treatment 50 that they can lve a full fe, The test involves taking a small sample of blood. The tests fee and available at clnis, hospitals, and HIV counseling and testing sites Test results ae kept confident. ‘+ When a person is first infected with HIV itcan take 3 or more months for the test to detect the infection, This is calle the "window period” and isthe ¥eason why repeat esting is important, A positive test result means the person is ileced with HIV and ean transit the visto others. * A negative test result can mean th person i not infected or that she isin the “window period”. Another test shouldbe taken within 3 months. the second tests still negative, the person is curently not ving wih HIV bat can sul become infected with HIV + HIV sa serually transmitted infection (STD 1tis important to ask your seaual partners) 10 be tested too. >. Emphasize tothe clin that prevention, early detsction, and prom management of STi, including HIV ae beneficial tohe/him, hee partner and lay and the community at age "Note: In 2007, WHO and UNAIDS isued guidance on provider nied HIV esting and counseling (PETC) in healt facies to support increased upake and improve acces to HIV prevention, teatmert and cae. in order to increase ‘uptake and improve access to HIV prevention, HIV counseling and testing, (ATO) shouldbe expanded in antenatal care, STI and TB clinics, and other linia settings as well as through outreach far mos at risk populations. © er or initiate HIV testing, according (o national protocols vesting snot. taille refer cent to specialized HTC services Counsel cient on resus of HIV test. "ests postive, review Poste Heath, Digi & Prevention counseling card ind refer chien o center for wellness care and treatment ‘Ste=p18. Give followup instructions, a condom brochure, and the brochure for method chosen, Seta date for next visit. 1. grumarize key pont discussed sbout the contaepive method chosen and ‘out STMIV ad cher services. Alte cet whither she hee inswer all questions belo proceding 2. ovide the client wit follow-up instructions forthe method chosen and the arresponding method brochure i the cen doesnot yt have one) 3. Ge the clint a brochure on condoms Resterate he fact that only condoms ovide dal protection against bath ST, inludirg HIV. and progranesMake sure the client has hisfer method or back-up method teers needed, 5. _Reiterate the importance of seeking other recommended services and provide 8 Proper teeral tothe lent © Fixa date forthe next vist wih the client. The purpose ofthe appointment may "Check on how the client is using the method, * Provide new supply of the method. * Provide information and support needed forthe client to continue using the ‘method coneety and consistently of to select another method! Bring the partner for further counseling ea family planning andr STUHNV. + Hove an HIV test 7. Encourage the client to etur tothe facilty any time she has a question or wishes o change methods, Remember: A cet has the right to change evs reproductive gals and to top using a family planning method ifs/he wishes or when she wants to have a chil ‘To the exent possible, anticipate the clint’ fuure needs. For Explain oa client using the Pil that, iit mete convenient for her, she ‘an gether supplies at local pharmacy. Reena her that the pharmacy may have the 21-pill pack instead ofthe 28-pill pac, inthis cas, she will yoed fo follow the instructions for use in the pil pack brochure or package nent ‘Stop 18. Thank herihim for the visit. Complete the counseling session, 1. _Asyou end the session, remember to be warm and cordial. This attiude wil encourage the client to feel welcome to rem,Guidelines for Adapi Plus Job Aids ig the Balanced Counseling Strategy ress as ar generic and an he evisedbased on a elon or county needs ind norms, Below are guidelines for adapting the job aids, 1 Condi technic review of amily plmsng and HCT norms and practies in ZOfr felon oF county: Below are some examsles othe kind oferta il on family planning, integrated health seices, and HC ©) As servis providers wth experince in counsling cents on fay Planning and HIV C1 to review the BCS+ jb ads for comese (© he job aids wil accompany traning, work withthe rains o define the ested competencies (sils)-fom the trsnng tobe incorporated ite ie, job ai. 2- Dec whether there are regional or loca sues that you would keto inroonae ic the BCS saegy (eg, acessilly of cern methods, Tuners to HIV and STIs through early mage female genta ation! ‘uttng, or practice of dry sex), Tee pate lechca eve nd cl noms af the county revise the eps Inthe BCSe,tsnecded. If the BCS+ is tevised, be sure to gates fomaae yo ‘just the algo, counsling cards, and brecures according ‘+ Revs the BCS jobads based onthe techncalrevew Below ate simple Buidelines for adaping the job aids 2) Adhere tothe existing formato the BCS jb alsa much as possible. They ate writen using avery specific methodology that hasbeen fe! ested and Proven to help providers effectively act on tne instructions Eitdng/evisng steps othe algorithm, wite the steps using action verbs Forexample, Ask the len whether she has hd her monthly bleeding. ~ ‘Remind he client to take the pill everyday atthe sane me. © Teche any sub-steps needed o perfor the sep. Do no assume that the » with an action ver, dL sence provider RET TECoa as par ofa sep, make a steps to enable the provider to cary out the BCS+ most efecvely a a”(6. Ask wo to thre less experienced service providers o use the revised BCS job aids and observe whether they were able vo perform the tasks based om the Instructions in the job aids. 7. Revise the job ids accordingly. Take into consideration any additional inpat service providers give you on how to improve the instructions, 8. needed,transate revised job ads into the local language. Be sure to have another person reverse- translate them to make sie the meaning hs nat ‘changed in the translation process. 9. Incorporate the use of the jb as into existing taining, or develop & shor ‘couse 10 show service providers how to use the jo ai Important! ‘A job aid shoul always be atcompanied by taining supportReferences ‘Askew, Jan, 2007. “Achieving synergies in prevention through linking sexual and ‘reproductive Health and HIV services,” in Donta, Balai etal. (eds), Procedings ofthe international Canferenc on Actions to Strengthen Linkages between Sexual and Reproductive Health and HIVIAIDS. Mumbai: Indian Society for the Study f Reproduction and Fertlty and World Heath Organization ‘Central Bureau of Statistics (CBS) [Kenyal, Ministry of Health (MOH) [Kenya and ‘ORC Macro. 2004, Kenyet Demographic and Health Survey 2003. Calverton, ‘Maryland: CBS, MOH, and ORC Macro, “Engendetheath and Planned Parenthood Association of South Africa. 2001 ‘Curriculum entitled Men As Partners: A Program for Supplementing the “raining of Life Sls Edvcatrs, 2nd Editon. New York: Engenderhealth and Planned Parenthood of South Aria, 2002. Hatcher, RA eal, 2008. Contraceptive Technology. Eighteenth Revised Editon. New York: Ardent Media ‘Leon, Federico R, 1999. Peru: Provides’ compliance with quality of ere norms,” FRONTIERS Final Report. Washington, DC: Popalation Counc. ‘Leon, Federico R etal. 2001. “Length of counseling sessions and the amount of relevant information exchanged: A study in Peruvian clinics” International Family Planning Perspectives 27(1)28-33, 48, 1e6n, Federico R etal. 2008, “Effects of 16S jb ads-asisted balanced counseling algorithms on quality of cate and client oucomes (Guatemala),” FRONTIERS Final Report. Washington, DC: Population Counc ‘Leon, Federico Reta. 2003b. “Enhancing quality for clients: The Balanced ‘Counseling Strategy” FRONTIERS Program Brif No.3. Washingion, DC: Population Council 1Le6n, Federico R, etal. 20036. “Testing balanced 2ounseling to improve provider- lien interaction in Guatemalas MOH elites.” FRONTIERS Fina Report ‘Washington, DC: Population Counc ‘Leon, Federico R. tal. 2004. “One-year client impacts of quality ofcaré improvements achieved in Peru," FRONTIERS Final Report. Washington, DC: Population Covneil Leon, Federico, Ricardo Vernon, Antonieta Martin, and Linda Bruce. 2008. The ‘Balanced Counseling Strategy: A Tool or Family Panning Serice Proves ‘Washingion, DC: Population CouncLLinbsla, Wilson etal. 2008, "Feasbily, effectiveness an cost of models of ‘integrating counseling and sting for HIV withir may plannirg services in Kenya,” FRONTIERS Firal Report. Washing, DC Population ~Counell Mullick, Saiga, Manishi Manziva, Docor Khoza, nd Eevin Maroga.2 008, “Feasblyeflecttvness and cost of model of irgrating coun-seling and testing for HIV within fami planning serves in North West Psovince, South ‘Avica,” FRONTIERS Final Report. Washington, DC: Population Counc ‘Stamback, J etal, 1999. "Chellis for ruling out pegnancy among far-aly-planning, cients in primary cre, Larcet 354{9178):56. ‘World Health Organization 2003, Guidelines forthe Management of Sextaaly Transit Infections. Geneva: WHO. 2004, Medial Egbity Criteria or Conbacepete Use, 3rd ed Geneva: WHO, ~ 2005, Sealy Tansmiied and Other Repraducive Tract nec ons A Gude to ‘Essential Practice Geneva: WHO. ~ 2010a. Medial Highly Criteria for Contracepéve Use. 4th ec, Geneva WHO, = 2010b. WHO Tehnical Consultation on Postpartum and Posinctal Care. ‘Geneva: WHO. ‘Weld Health Organisation, Deparment of Reproductive Health snd Research (WHOY RHR) and Johns Egpins Bloomberg Schoo of Public HeaktvCenter for Communication Prgrams JHUCCP) INF Projet. 2007. Farnty Plamig: A (loa Handbok fer Provides. Balsmore and Gena: JHUCCP and WHO. ‘World Health Organization and Joint United Naticns Programme on HIV/AIDS (UNAIDS). Guida on Provider-Iniated HIV Testing and Connseling in Health Facilites. Gneva: WHO.‘he Population Coun endvts esearch workite {to inpiove pct, programs, nd paductsia tae areas: HI and AIDS; poverty, poder, and youth; and reproductive heath Fo ational infomation plas conte: Popsiaon Coane aah 4901 Comectut Av. NM, Suite 280, Washington, OC 20008 USA “Tebphone (202) 237 8400 sie: 202) 237.8410 mui ubcatonspopcouc.org ww popeounc ary