Birdthistle Isolde J, Fenty Justin, Collumbien Martine, Warren Charlotte, Kimani James, Ndwiga Charity, Mayhew Susannah
Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
BMJ Glob Health. 2018 Sep 14;3(5):e000867. doi: 10.1136/bmjgh-2018-000867. eCollection 2018.
Integration of HIV/AIDS with reproductive health (RH) services can increase the uptake and efficiency of services, but gaps in knowledge remain about the practice of integration, particularly how provision can be expanded and performance enhanced. We assessed the extent and nature of service integration in public sector facilities in four districts in Kenya.
Between 2009 and 2012, client flow assessments were conducted at six time points in 24 government facilities, purposively selected as intervention or comparison sites. A total of 25 539 visits were tracked: 15 270 in districts where 6 of 12 facilities received an intervention to strengthen HIV service integration with family planning (FP); and 10 266 visits in districts where half the facilities received an HIV-postnatal care intervention in 2009-2010. We tracked the proportion of all visits in which: (1) an HIV service (testing, counselling or treatment) was received together with an RH service (FP counselling or provision, antenatal care, or postnatal care); (2) the client received HIV counselling.
Levels of integrated HIV-RH services and HIV counselling were generally low across facilities and time points. An initial boost in integration was observed in most intervention sites, driven by integration of HIV services with FP counselling and provision, and declined after the first follow-up. Integration at most sites was driven by temporary rises in HIV counselling. The most consistent combination of HIV services was with antenatal care; the least common was with postnatal care.
These client flow data demonstrated a short-term boost in integration, after an initial intervention with FP services providing an opportunity to expand integration. Integration was not sustained over time highlighting the need for ongoing support. There are multiple opportunities for integrating service delivery, particularly within antenatal, FP and HIV counselling services, but a need for sustained systems and health worker support over time.
NCT01694862.
将艾滋病毒/艾滋病与生殖健康（RH）服务相结合可提高服务的接受度和效率，但在服务整合实践方面仍存在知识差距，特别是在如何扩大服务提供范围和提高服务绩效方面。我们评估了肯尼亚四个地区公共部门设施中服务整合的程度和性质。
2009年至2012年期间，在24个政府设施的六个时间点进行了客户流量评估，这些设施是有意挑选作为干预或对照地点的。总共跟踪了25539次就诊：在12个设施中有6个接受加强艾滋病毒服务与计划生育（FP）整合干预的地区有15270次就诊；在2009 - 2010年期间一半设施接受艾滋病毒产后护理干预的地区有10266次就诊。我们跟踪了所有就诊中以下情况的比例：（1）接受艾滋病毒服务（检测、咨询或治疗）的同时接受生殖健康服务（计划生育咨询或服务、产前护理或产后护理）；（2）客户接受艾滋病毒咨询。
在各个设施和时间点，艾滋病毒 - 生殖健康服务整合水平和艾滋病毒咨询水平总体较低。在大多数干预地点，由于艾滋病毒服务与计划生育咨询及服务的整合，观察到整合情况最初有所提升，但在首次随访后下降。大多数地点的整合是由艾滋病毒咨询的临时增加推动的。艾滋病毒服务最一致的组合是与产前护理；最不常见的是与产后护理。
这些客户流量数据表明，在最初通过计划生育服务进行干预以提供扩大整合机会后，整合情况有短期提升。随着时间的推移，整合并未持续，这凸显了持续支持的必要性。存在多个整合服务提供的机会，特别是在产前、计划生育和艾滋病毒咨询服务方面，但需要随着时间的推移提供持续的系统和卫生工作者支持。
NCT01694862。
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