Integration of Family Planning Services Into Anticoagulation Monitoring Services
Condition: Contraception
Study type: Interventional

Summary: 
      Currently there are approximately 400 women of reproductive age enrolled in outpatient
      monitoring of warfarin therapy through AMS. The investigators do not have any data on the
      percentage of women who are using family planning, but anecdotally the providers report that
      it is very low. The investigators believe that an educational intervention with an emphasis
      on the safest and most effective methods, long-acting reversible contraception (LARC), aimed
      specifically toward women with medical conditions requiring anticoagulation, combined with
      on-site provision of LARC can improve uptake of these methods. Ultimately, the use of the
      most effective methods of contraception will prevent unplanned pregnancy and the unnecessary
      maternal morbidity and mortality associated with high-risk pregnancies in women with these
      conditions.
    

Detailed description: 
      The investigators' hypothesis is that implementation of an educational intervention
      emphasizing long-acting reversible contraception (LARC) combined with free on-site provision
      of LARC within Anticoagulation Monitoring Service (AMS) can improve uptake of these methods
      by 250% in this population.

      Our objectives are to:

        1. Determine whether integration of education about and free provision of highly effective
           long-acting reversible contraceptive methods within Anticoagulation Monitoring Services
           (AMS) is feasible.

        2. Determine whether integration of education about and free provision of highly effective
           long-acting reversible contraceptive methods within Anticoagulation Monitoring Services
           (AMS) can improve uptake of long-acting reversible contraceptive methods (IUCDs and
           contraceptive implants).

        3. Determine whether integration of education about and free provision of highly effective
           long-acting reversible contraceptive methods within an Anticoagulation Monitoring
           Services (AMS) Clinic can prevent unplanned pregnancies.

      The investigators will perform a prospective cohort study of all women of reproductive age
      seen in Anticoagulation Monitoring Service (AMS). Women who agree to enrollment will undergo
      our intervention, which will include an educational intervention and free on-site provision
      of all reversible contraceptive options, including LARC. This educational intervention will
      be a one-on-one educational session on all available methods of contraception, with an
      emphasis on the safety and efficacy of long-acting reversible contraception (LARC) and the
      importance of planning a pregnancy in women with medical conditions requiring
      anticoagulation. A provider (clinic officer, nurse or physician) trained in family planning
      counseling and provision will provide all counseling and discussions in Kiswahili. Women will
      then be offered free, on-site provision of whichever contraceptive method they choose by a
      trained provider. During the intervention period we intend to capture all women currently
      actively enrolled in AMS, which is currently approximately 400 women. Each woman generally
      attends AMS clinic once per month, so the investigators expect that it will take about three
      months to capture all women at least once. These women will then be followed prospectively
      over the next one-year time period to evaluate for uptake of a contraceptive method and
      subsequent pregnancy. The investigators will then compare participants' method of
      contraception used prior to the intervention and participants' method of contraception used
      after the intervention. The investigators will specifically evaluate for an increase in the
      use of IUCDs and contraceptive implants.
    

Intervention name(s): Integrated Family Planning Services
Intervention type(s): Other
Intervention description(s): Women who agree to enrollment will undergo our intervention, which will include an educational intervention and free on-site provision of all reversible contraceptive options, including LARC. This educational 5 intervention will be a one-on-one educational session on all available methods of contraception, with an emphasis on the safety and efficacy of long-acting reversible contraception (LARC) and the importance of planning a pregnancy in women with medical conditions requiring anticoagulation. A provider (clinic officer, nurse or physician) trained in family planning counseling and provision will provide all counseling and discussions in Kiswahili. Women will then be offered free, on-site provision of whichever contraceptive method they choose by a trained provider.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment