Exploring the Feasibility of Service Integration in a Low-Income Setting: A Mixed Methods Investigation into Different Models of Reproductive Health and HIV Care in Swaziland.
Exploring the Feasibility of Service Integration in a Low-Income Setting: A Mixed Methods Investigation into Different Models of Reproductive Health and HIV Care in Swaziland.
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DOI：
10.1371/journal.pone.0126144
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Mayhew SH
中科院分区：
文献类型：
--
作者：
Church K;Wringe A;Lewin S;Ploubidis GB;Fakudze P;Integra Initiative;Mayhew SH
将生殖健康与艾滋病毒护理相结合是艾滋病毒高流行率环境中的一个政策优先事项，尽管其可行性受到质疑，而且对健康结果的影响证据也不尽相同。综合生殖健康-艾滋病毒护理的过程和成果进行了调查，在斯威士兰，通过比较案例研究的四种服务模式，从完全整合到完全独立的艾滋病毒服务，有目的地选择在一个城镇。客户退出调查（n=602）衡量综合护理收到和未满足的计划生育（FP）的需求。描述性统计被用来评估每个诊所的整合程度和客户的服务需求。逻辑回归模型被用来测试的假设，即客户在更一体化的网站比客户在一个独立的网站有较低的未满足的计划生育需求。定性方法包括与客户和提供者进行深入访谈，探讨影响生殖健康-艾滋病毒综合护理服务可行性的背景因素;数据按主题进行分析，结合演绎和归纳方法。结果表明，临床模型在实践中并不像声称的那样完整。艾滋病毒护理分散的情况很普遍。尽管报告了需求，但与独立模式相比，综合诊所的每个提供者获得的服务并不高（p>0.05）。虽然妇女在更综合的网站得到更多的计划生育和怀孕咨询比独立的模式，他们收到避孕套（一种选择的方法）不太经常，有没有统计证据的差异，在未满足的计划生育需求的护理模式。多种背景因素影响整合的做法，包括供应商的技能下降内专科的角色;规范的任务导向的个性化艾滋病毒护理;沉重的客户负载的看法;不平衡的客户-供应商的互动阻碍生殖健康需求的表达;和供应商的动机挑战。因此，尽管有机构支持，但与护理的社会背景有关的因素阻碍了在这些诊所提供生殖健康-艾滋病毒全面综合服务。如果综合护理干预措施要持续下去，方案就不应局限于简单的培训和提供设备。
Integrating reproductive health (RH) with HIV care is a policy priority in high HIV prevalence settings, despite doubts surrounding its feasibility and varying evidence of effects on health outcomes. The process and outcomes of integrated RH-HIV care were investigated in Swaziland, through a comparative case study of four service models, ranging from fully integrated to fully stand-alone HIV services, selected purposively within one town. A client exit survey (n=602) measured integrated care received and unmet family planning (FP) needs. Descriptive statistics were used to assess the degree of integration per clinic and client demand for services. Logistic regression modelling was used to test the hypothesis that clients at more integrated sites had lower unmet FP needs than clients in a stand-alone site. Qualitative methods included in-depth interviews with clients and providers to explore contextual factors influencing the feasibility of integrated RH-HIV care delivery; data were analysed thematically, combining deductive and inductive approaches. Results demonstrated that clinic models were not as integrated in practice as had been claimed. Fragmentation of HIV care was common. Services accessed per provider were no higher at the more integrated clinics compared to stand-alone models (p>0.05), despite reported demand. While women at more integrated sites received more FP and pregnancy counselling than stand-alone models, they received condoms (a method of choice) less often, and there was no statistical evidence of difference in unmet FP needs by model of care. Multiple contextual factors influenced integration practices, including provider de-skilling within sub-specialist roles; norms of task-oriented routinised HIV care; perceptions of heavy client loads; imbalanced client-provider interactions hindering articulation of RH needs; and provider motivation challenges. Thus, despite institutional support, factors related to the social context of care inhibited provision of fully integrated RH-HIV services in these clinics. Programmes should move beyond simplistic training and equipment provision if integrated care interventions are to be sustained.
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影响因子：
6
作者：
Church K;Wringe A;Fakudze P;Kikuvi J;Simelane D;Mayhew SH;Integra Initiative
通讯作者：
Integra Initiative
影响因子：
168.9
作者：
Gilks, Charles F.;Crowley, Siobhan;De Cock, Kevin
通讯作者：
De Cock, Kevin
影响因子：
5.4
作者：
Dixon-Woods, Mary;Suokas, Anu;Tarrant, Carolyn
通讯作者：
Tarrant, Carolyn
影响因子：
168.9
作者：
Ekman, Bjorn;Pathmanathan, Indra;Liljestrand, Jerker
通讯作者：
Liljestrand, Jerker
影响因子：
3.2
作者：
Baumgartner, Joy Noel;Green, Mackenzie;Lasway, Christine
通讯作者：
Lasway, Christine