Phiri Sam, Feldacker Caryl, Chaweza Thomas, Mlundira Linly, Tweya Hannock, Speight Colin, Samala Bernadette, Kachale Fannie, Umpierrez Denise, Haddad Lisa
Executive Director, The Lighthouse Trust, Lilongwe, Malawi and Professor, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Monitoring, Evaluation and Research Technical Advisor, The Lighthouse Trust, Lilongwe, Malawi and International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA.
J Fam Plann Reprod Health Care. 2016 Jan;42(1):17-23. doi: 10.1136/jfprhc-2013-100816. Epub 2015 Apr 22.
Lighthouse Trust operates two public HIV testing, treatment and care clinics in Lilongwe, Malawi, caring for over 26 000 people living with HIV, 23 000 of whom are on antiretroviral treatment (ART). In August 2010, Lighthouse Trust piloted a step-wise integration of sexual and reproductive health (SRH) services into routine HIV care at its Lighthouse clinic site. The objectives were to increase uptake of family planning (FP), promote long-term reversible contraceptive methods, and increase access, screening and treatment for cervical cancer using visual inspection with acetic acid.
Patients found integrated SRH/ART services acceptable; service availability appeared to increase uptake. Between August 2010 and May 2014, over 6000 women at Lighthouse received FP education messages. Of 859 women who initiated FP, 55% chose depot medroxyprogesterone acetate, 19% chose an intrauterine contraceptive device, 14% chose oral contraceptive pills, and 12% chose an implant. By May 2014, 21% of eligible female patients received cervical cancer screening: 11% (166 women) had abnormal cervical findings during screening for cervical cancer and underwent further treatment.
Several lessons were learned in overcoming initial concerns about integration. First, our integrated services required minimal additional resources over those needed for provision of HIV care alone. Second, patient flow improved during implementation, reducing a barrier for clients seeking multiple services. Lastly, analysis of routine data showed that the proportion of women using some form of modern contraception was 45% higher at Lighthouse than at Lighthouse's sister clinic where services were not integrated (42% vs 29%), providing further evidence for promotion of SRH/ART integration.
灯塔信托基金在马拉维的利隆圭运营着两家公共艾滋病毒检测、治疗和护理诊所，为超过26000名艾滋病毒感染者提供护理，其中23000人正在接受抗逆转录病毒治疗（ART）。2010年8月，灯塔信托基金在其灯塔诊所试点将性健康和生殖健康（SRH）服务逐步纳入常规艾滋病毒护理。目标是提高计划生育（FP）的使用率，推广长效可逆避孕方法，并通过醋酸目视检查增加宫颈癌的筛查、诊断和治疗。
患者认为综合的性健康和生殖健康/抗逆转录病毒治疗服务是可以接受的；服务的可及性似乎提高了使用率。2010年8月至2014年5月期间，灯塔诊所超过6000名女性接受了计划生育教育信息。在859名开始使用计划生育服务的女性中，55%选择了醋酸甲羟孕酮长效避孕针，19%选择了宫内节育器，14%选择了口服避孕药，12%选择了皮下埋植剂。到2014年5月，21%符合条件的女性患者接受了宫颈癌筛查：11%（166名女性）在宫颈癌筛查中发现宫颈异常并接受了进一步治疗。
在克服对整合的最初担忧方面我们吸取了几个教训。第一，我们的综合服务所需的额外资源比仅提供艾滋病毒护理所需的资源少。第二，实施过程中患者流量有所改善，减少了寻求多种服务的客户的障碍。最后，对常规数据的分析表明，灯塔诊所使用某种形式现代避孕方法的女性比例比未整合服务的灯塔姐妹诊所高45%（42%对29%），为促进性健康和生殖健康/抗逆转录病毒治疗整合提供了进一步证据。
