Baumgartner Joy Noel, Green Mackenzie, Weaver Mark A, Mpangile Gottlieb, Kohi Thecla W, Mujaya Stella N, Lasway Christine
FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania
FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania.
Health Policy Plan. 2014 Aug;29(5):570-9. doi: 10.1093/heapol/czt043. Epub 2013 Jul 26.
Many clients of HIV care and treatment services have unmet contraceptive needs. Integrating family planning (FP) services into HIV services is an increasingly utilized strategy for meeting those unmet needs. However, numerous models for services integration are potentially applicable for clients with diverse health needs. This study developed and tested a 'facilitated referral' model for integrating FP into HIV care and treatment in Tanzania with the primary outcome being a reduction in unmet need for contraception among female clients.
The facilitated referral model included seven distinct steps for service providers. A quasi-experimental, pre- and post-test, repeated cross-sectional study was conducted to evaluate the impact of the model. Female clients at 12 HIV care and treatment clinics (CTCs) were interviewed pre- and post-intervention and CTC providers were interviewed post-intervention.
A total of 323 CTC clients were interviewed pre-intervention and 299 were interviewed post-intervention. Among all clients, the adjusted decrease in proportion with unmet need (3%) was not significant (P = 0.103) but among only sexually active clients, the adjusted decrease (8%) approached significance (P = 0.052). Furthermore, the proportion of sexually active clients using a contraceptive method post-intervention increased by an estimated 12% (P = 0.013). Dual method use increased by 16% (P = 0.004). Increases were observed for all seven steps of the model from pre- to post-intervention. All providers (n = 45) stated that FP integration was a good addition although there were implementation challenges.
This study demonstrated that the facilitated referral model is a feasible strategy for integrating FP into HIV care and treatment services. The findings show that this model resulted in increased contraceptive use among HIV-positive female clients. By highlighting the distinct steps necessary for facilitated referrals, this study can help inform both programmes and future research efforts in services integration.
许多接受艾滋病毒护理和治疗服务的客户有未满足的避孕需求。将计划生育（FP）服务纳入艾滋病毒服务是满足这些未满足需求的一种越来越常用的策略。然而，有许多服务整合模式可能适用于有不同健康需求的客户。本研究开发并测试了一种将计划生育纳入坦桑尼亚艾滋病毒护理和治疗的“便利转诊”模式，主要结果是减少女性客户未满足的避孕需求。
便利转诊模式为服务提供者包括七个不同步骤。进行了一项准实验性的前后测试、重复横断面研究，以评估该模式的影响。对12家艾滋病毒护理和治疗诊所（CTCs）的女性客户在干预前后进行了访谈，并在干预后对CTCs提供者进行了访谈。
共有323名CTCs客户在干预前接受了访谈，299名在干预后接受了访谈。在所有客户中，未满足需求比例的调整后下降（3%）不显著（P = 0.103），但仅在性活跃客户中，调整后下降（8%）接近显著（P = 0.052）。此外，干预后使用避孕方法的性活跃客户比例估计增加了12%（P = 0.013）。双重方法使用增加了16%（P = 0.004）。从干预前到干预后，该模式的所有七个步骤都有增加。所有提供者（n = 45）表示，纳入计划生育是一个很好的补充，尽管存在实施挑战。
本研究表明，便利转诊模式是将计划生育纳入艾滋病毒护理和治疗服务的可行策略。研究结果表明，该模式导致艾滋病毒阳性女性客户的避孕使用率增加。通过强调便利转诊所需的不同步骤，本研究可为服务整合方面的项目和未来研究工作提供参考。
