计划生育与艾滋病毒检测及咨询服务整合的机构准备情况的决定因素：来自2014 - 2015年坦桑尼亚服务提供评估调查的证据
Determinants of facility readiness for integration of family planning with HIV testing and counseling services: evidence from the Tanzania service provision assessment survey, 2014-2015.
作者信息
Bintabara Deogratius, Nakamura Keiko, Seino Kaoruko
机构信息
Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Public Health, College of Health Sciences, The University of Dodoma, P.O Box 259, Dodoma, Tanzania.
出版信息
BMC Health Serv Res. 2017 Dec 22;17(1):844. doi: 10.1186/s12913-017-2809-8.
BACKGROUND
Global policy reports, national frameworks, and programmatic tools and guidance emphasize the integration of family planning and HIV testing and counseling services to ensure universal access to reproductive health care and HIV prevention. However, the status of integration between these two services in Tanzanian health facilities is unclear. This study examined determinants of facility readiness for integration of family planning with HIV testing and counseling services in Tanzania.
METHODS
Data from the 2014-2015 Tanzania Service Provision Assessment Survey were analyzed. Facilities were considered ready for integration of family planning with HIV testing and counseling services if they scored ≥ 50% on both family planning and HIV testing and counseling service readiness indices as identified by the World Health Organization. All analyses were adjusted for clustering effects, and estimates were weighted to correct for non-responses and disproportionate sampling. Descriptive, bivariate, and multivariate logistic regression analyses were performed.
RESULTS
A total of 1188 health facilities were included in the study. Of all of the health facilities, 915 (77%) reported offering both family planning and HIV testing and counseling services, while only 536 (45%) were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned [AOR = 3.2; 95%CI, 1.9-5.6], having routine management meetings [AOR = 1.9; 95%CI, 1.1-3.3], availability of guidelines [AOR = 3.8; 95%CI, 2.4-5.8], in-service training of staff [AOR = 2.6; 95%CI, 1.3-5.2], and availability of laboratories for HIV testing [AOR = 17.1; 95%CI, 8.2-35.6].
CONCLUSION
The proportion of facility readiness for the integration of family planning with HIV testing and counseling in Tanzania is unsatisfactory. The Ministry of Health should distribute and ensure constant availability of guidelines, availability of rapid diagnostic tests for HIV testing, and the provision of refresher training to health providers, as these were among the determinants of facility readiness.
背景
全球政策报告、国家框架以及规划工具与指南都强调将计划生育与艾滋病毒检测及咨询服务相结合，以确保普遍获得生殖健康护理和艾滋病毒预防服务。然而，坦桑尼亚医疗机构中这两项服务的整合状况尚不清楚。本研究调查了坦桑尼亚医疗机构对计划生育与艾滋病毒检测及咨询服务整合的准备情况的决定因素。
方法
对2014 - 2015年坦桑尼亚服务提供评估调查的数据进行了分析。如果医疗机构在世界卫生组织确定的计划生育和艾滋病毒检测及咨询服务准备指数上得分均≥50%，则认为其准备好将计划生育与艾滋病毒检测及咨询服务进行整合。所有分析都对聚类效应进行了调整，估计值进行了加权以校正无应答和抽样不均衡的情况。进行了描述性、双变量和多变量逻辑回归分析。
结果
该研究共纳入了1188家医疗机构。在所有医疗机构中，915家（77%）报告同时提供计划生育和艾滋病毒检测及咨询服务，而只有536家（45%）被认为准备好整合这两项服务。医疗机构准备好整合这两项服务的显著决定因素包括为政府所有[AOR = 3.2；95%CI，1.9 - 5.6]、召开常规管理会议[AOR = 1.9；95%CI，1.1 - 3.3]、有指南可用[AOR = 3.8；95%CI，2.4 - 5.8]、工作人员接受在职培训[AOR = 2.6；95%CI，1.3 - 5.2]以及有用于艾滋病毒检测的实验室[AOR = 17.1；95%CI，8.2 - 35.6]。
结论
坦桑尼亚医疗机构对计划生育与艾滋病毒检测及咨询进行整合的准备比例不令人满意。卫生部应分发并确保指南随时可用、提供用于艾滋病毒检测的快速诊断测试以及为卫生服务提供者提供进修培训，因为这些是医疗机构准备情况的决定因素。
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