Milford Cecilia, Greener Letitia Rambally, Beksinska Mags, Greener Ross, Mabude Zonke, Smit Jenni
a MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences , University of the Witwatersrand , Durban , South Africa.
Afr J AIDS Res. 2018 Jul;17(2):183-192. doi: 10.2989/16085906.2018.1478314.
In South Africa, a lack of integration between sexual and reproductive health (SRH) and HIV services has led to lost opportunities in the treatment cascade. In a context of high HIV, tuberculosis (TB) and unplanned pregnancies, a model for integrating SRH and HIV services was implemented in a hospital and six feeder clinics in KwaZulu-Natal, South Africa. Changes in healthcare provider knowledge, attitudes and understandings were explored following model implementation. Baseline data were collected via focus group discussions (FGDs) and a cross-sectional survey, and were used to inform the development of a model for integrating SRH and HIV services. Following the implementation of the model, an endline survey was conducted to explore any changes. Four FGDs were conducted with healthcare providers at study facilities. A total of 46 providers participated in the baseline survey, and 44 in the endline survey. Qualitative data were thematically analysed using NVivo 11, and quantitative data were descriptively analysed using SPSS 24. The understanding of integration improved by endline. Integration of services was considered important for reducing stigma and increasing access to and improving quality of care. Concerns raised were that integration would increase workload and time per client. Physical structure of facilities was not always conducive to referral or integration. Perceived benefits of integration and actual integration of services improved between baseline and endline. Enhanced understanding of integration and increased levels of reported integration over time imply that providers are more aware, suggesting that the model was effective. Provider perspectives and understandings are important for the successful integration of services. This integration model is relevant and useful to inform training and mentoring of providers, as well as to provide recommendations for policy implementation.
在南非，性健康和生殖健康（SRH）与艾滋病毒服务之间缺乏整合，导致在治疗流程中错失了机会。在艾滋病毒、结核病（TB）高发以及意外怀孕频发的背景下，南非夸祖鲁 - 纳塔尔省的一家医院和六家基层诊所实施了一项整合SRH与艾滋病毒服务的模式。在该模式实施后，对医疗服务提供者的知识、态度和理解的变化进行了探索。通过焦点小组讨论（FGD）和横断面调查收集基线数据，并将其用于指导整合SRH与艾滋病毒服务模式的制定。在模式实施后，进行了一项终期调查以探索任何变化。在研究机构与医疗服务提供者进行了四次FGD。共有46名提供者参与了基线调查，44名参与了终期调查。使用NVivo 11对定性数据进行主题分析，使用SPSS 24对定量数据进行描述性分析。到终期时对整合的理解有所改善。服务整合被认为对于减少耻辱感以及增加获得护理的机会和提高护理质量很重要。提出的担忧是整合会增加工作量和每位客户的时间。设施的物理结构并不总是有利于转诊或整合。在基线和终期之间，对整合的感知益处和服务的实际整合有所改善。随着时间的推移，对整合的理解增强以及报告的整合水平提高意味着提供者更加了解情况，表明该模式是有效的。提供者的观点和理解对于服务的成功整合很重要。这种整合模式对于为提供者的培训和指导提供信息以及为政策实施提供建议具有相关性和实用性。
