Jhpiego Kenya, Nairobi, Kenya.
Jhpiego Baltimore, Baltimore, MD, USA.
Reprod Health. 2019 May 29;16(Suppl 1):62. doi: 10.1186/s12978-019-0715-8.
Kenya has made remarkable progress in integrating a range of reproductive health services with HIV/AIDS services over the past decade. This study describes a sub-set of outcomes from the Bill & Melinda Gates Foundation (BMGF)-funded Jhpiego-led Kenya Urban Reproductive Health Initiative (Tupange) Project (2010-2015), specifically addressing strengthening family planning (FP) integration with a range of primary care services including HIV testing and counselling, HIV care services, and maternal, newborn and child care.
A cross-sectional study was conducted between August and October 2013 in the cities of Mombasa, Nairobi and Kisumu in Kenya to assess the level of FP integration across six other service delivery areas (antenatal care clinic, maternity wards, postnatal care clinic, child welfare clinic, HIV testing and counseling (HTC) clinics, HIV/AIDS services in comprehensive care clinics). The variables of interest were level of integration, provider knowledge, and provider skills. Routine program monitoring data on workload was utilized for sampling, with additional data collected and analyzed from twenty health facilities selected for this study, along with client exit interviews. Descriptive analysis and Chi-square/ Fishers Exact tests were done to explore relationships between variables of interest.
Integration of FP occurred in all the five service areas to varying degrees. Service provider FP knowledge in four service delivery areas (HTC clinic, antenatal clinic, postnatal clinic, and child welfare clinic) increased with increasing levels of integration. Forty-seven percent of the clients reported that time spent accessing FP services in the HTC clinic was reasonable. However, no FP knowledge was reported from service providers in HIV/AIDS comprehensive care clinics in all levels of integration despite observed provision of counseling and referral for FP services.
Integration of FP services in other primary care service areas including HTC clinic can be enhanced through targeted interventions at the facility. A holistic approach to address service providers' capacity and attitudes, ensuring FP commodity security, and creating a supportive environment to accommodate service integration is necessary and recommended. Additional studies are necessary to identify ways of enhancing FP integration, particularly with HIV/AIDS care services.
在过去十年中，肯尼亚在将一系列生殖健康服务与艾滋病毒/艾滋病服务相结合方面取得了显著进展。本研究描述了比尔及梅林达·盖茨基金会（BMGF）资助的 Jhpiego 领导的肯尼亚城市生殖健康倡议（Tupange）项目（2010-2015 年）的一部分结果，特别是解决了加强计划生育（FP）与一系列初级保健服务的整合问题，包括艾滋病毒检测和咨询、艾滋病毒护理服务以及孕产妇、新生儿和儿童保健。
2013 年 8 月至 10 月，在肯尼亚的蒙巴萨、内罗毕和基苏木市进行了一项横断面研究，以评估 FP 整合在其他六个服务提供领域（产前诊所、产房、产后诊所、儿童保健诊所、艾滋病毒检测和咨询（HTC）诊所、综合护理诊所中的艾滋病毒/艾滋病服务）的水平。感兴趣的变量是整合水平、提供者知识和提供者技能。利用常规方案监测数据对工作量进行抽样，从为这项研究选择的二十个卫生机构收集和分析额外的数据，以及客户退出访谈。进行描述性分析和卡方/ Fisher 精确检验，以探讨感兴趣变量之间的关系。
FP 在所有五个服务领域都以不同程度发生了整合。在四个服务提供领域（HTC 诊所、产前诊所、产后诊所和儿童保健诊所），服务提供者的 FP 知识随着整合水平的提高而增加。47%的客户报告说，在 HTC 诊所获得 FP 服务的时间是合理的。然而，尽管观察到提供了咨询和转介 FP 服务，但在所有整合水平的艾滋病毒/艾滋病综合护理诊所中，服务提供者都没有报告 FP 知识。
通过在医疗机构开展有针对性的干预措施，可以加强 FP 服务在其他初级保健服务领域，包括 HTC 诊所的整合。需要并建议采取整体方法来解决服务提供者的能力和态度问题，确保 FP 商品安全，并创造一个支持性的环境来容纳服务整合。需要进一步研究以确定加强 FP 整合的方法，特别是与艾滋病毒/艾滋病护理服务的整合。
