Integrating family planning services into HIV care and treatment clinics in Tanzania: evaluation of a facilitated referral model
Integrating family planning services into HIV care and treatment clinics in Tanzania: evaluation of a facilitated referral model
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DOI：
10.1093/heapol/czt043
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发表时间：
2014-08-01
影响因子：
3.2
通讯作者：
Lasway, Christine
中科院分区：
文献类型：
--
作者：
Baumgartner, Joy Noel;Green, Mackenzie;Lasway, Christine
背景 许多艾滋病毒护理和治疗服务的客户的避孕需求未得到满足。将计划生育 (FP) 服务纳入艾滋病毒服务是满足这些未满足需求的越来越多的策略。然而，多种服务整合模式可能适用于具有不同健康需求的客户。这项研究开发并测试了一种“便利转诊”模式，用于将计划生育纳入坦桑尼亚的艾滋病毒护理和治疗中，主要结果是减少女性客户未满足的避孕需求。方法 便利转诊模式包括服务提供者的七个不同步骤。进行了准实验、测试前和测试后的重复横断面研究，以评估该模型的影响。 12 个 HIV 护理和治疗诊所 (CTC) 的女性客户在干预前和干预后接受了访谈，CTC 提供者在干预后接受了访谈。结果 共有 323 名 CTC 客户在干预前接受了访谈，299 名 CTC 客户在干预后接受了访谈。在所有客户中，未满足需求的比例调整后的下降（3%）并不显着（P = 0.103），但仅在性活跃的客户中，调整后的下降（8%）接近显着性（P = 0.052）。此外，干预后性活跃的客户使用避孕方法的比例估计增加了 12%（P = 0.013）。双重方法的使用增加了 16% (P = 0.004)。从干预前到干预后，模型的所有七个步骤均观察到增加。所有提供者 (n = 45) 均表示，尽管存在实施挑战，但 FP 整合是一个很好的补充。 结论 本研究表明，便利转诊模式是将 FP 整合到 HIV 护理和治疗服务中的可行策略。研究结果表明，这种模式导致艾滋病毒呈阳性的女性顾客中避孕药具的使用增加。通过强调促进转诊所需的独特步骤，这项研究可以帮助为服务整合的计划和未来的研究工作提供信息。
Background Many clients of HIV care and treatment services have unmet contraceptive needs. Integrating family planning (FP) services into HIV services is an increasingly utilized strategy for meeting those unmet needs. However, numerous models for services integration are potentially applicable for clients with diverse health needs. This study developed and tested a 'facilitated referral' model for integrating FP into HIV care and treatment in Tanzania with the primary outcome being a reduction in unmet need for contraception among female clients.Methods The facilitated referral model included seven distinct steps for service providers. A quasi-experimental, pre- and post-test, repeated cross-sectional study was conducted to evaluate the impact of the model. Female clients at 12 HIV care and treatment clinics (CTCs) were interviewed pre- and post-intervention and CTC providers were interviewed post-intervention.Results A total of 323 CTC clients were interviewed pre-intervention and 299 were interviewed post-intervention. Among all clients, the adjusted decrease in proportion with unmet need (3%) was not significant (P = 0.103) but among only sexually active clients, the adjusted decrease (8%) approached significance (P = 0.052). Furthermore, the proportion of sexually active clients using a contraceptive method post-intervention increased by an estimated 12% (P = 0.013). Dual method use increased by 16% (P = 0.004). Increases were observed for all seven steps of the model from pre-to post-intervention. All providers (n = 45) stated that FP integration was a good addition although there were implementation challenges.Conclusion This study demonstrated that the facilitated referral model is a feasible strategy for integrating FP into HIV care and treatment services. The findings show that this model resulted in increased contraceptive use among HIV-positive female clients. By highlighting the distinct steps necessary for facilitated referrals, this study can help inform both programmes and future research efforts in services integration.