Systems analysis and improvement approach to improve integration of HIV prevention and treatment services

东非和南部非洲拥有世界6.2%的人口，但包括54%的生活在非洲的人。 艾滋病毒（艾滋病毒携带者）。在该区域，五分之三的艾滋病毒携带者是妇女，艾滋病毒的负担特别高 在少女和年轻妇女中的作用。超过一半的非洲妇女使用计划生育（FP） 服务将艾滋病毒预防和治疗与计划生育服务相结合有望支持进展 联合国艾滋病规划署95-95-95检测、治疗和预防的目标。尽管如此，即使 计划生育诊所的基本艾滋病毒预防和治疗服务仍然很低，如何最好地整合这些服务， 服务仍然是未知的。在以前的试验中，系统分析和改进方法（SAIA）是一种 有效实施战略，以改善艾滋病毒咨询和测试在一个小的选择计划生育诊所， 肯尼亚蒙巴萨县，由研究人员交付。SAIA结合了级联分析工具， 顺序流程图，以及微干预开发、实施和 评估，以改善护理级联。需要更多的数据来了解SAIA是否也有效 改善计划生育诊所与艾滋病毒护理和筛查的联系以及与暴露前预防的联系 当SAIA由肯尼亚公共卫生工作人员大规模提供时。本研究的第一个目标是 进行一项随机分组试验，评价SAIA与对照组（常规程序， 没有具体的干预措施），以增加艾滋病毒咨询，检测，与艾滋病毒护理的联系，以及筛查和联系 在新的FP客户和新的和返回AGYW客户的PrEP。将特别关注艾滋病毒 本研究中AGYW的预防和治疗以及任何接受FP治疗的AGYW将被优先考虑。 定量和定性数据将使用RE-AIM框架进行分析，以评估该计划的 覆盖范围、有效性、采用、实施和维护。为了了解SAIA如何能够 纳入国家卫生部的政策和计划，将进行基于活动的成本计算， 从卫生部评估SAIA的预算和计划影响，并将其扩展到县级 perspective.据推测，与对照组相比，SAIA将有效地增加艾滋病毒咨询， 艾滋病毒检测，与艾滋病毒护理的联系，以及为新的计划生育客户和所有新的 当肯尼亚公共卫生工作人员大规模提供时，返回AGYW FP客户。执行 评价、成本计算和预算影响分析将为国家一级的执行工作制定路线图， 将肯尼亚定位为计划生育/艾滋病毒综合服务的全球领导者。

East and Southern Africa is home to 6.2% of the world’s population but includes 54% of all people living with HIV (PLWH). In this region, three out of five PLWH are women, and there is a particularly high burden of HIV amongst adolescent girls and young women (AGYW). Over half of African women use family planning (FP) services. Integration of HIV prevention and treatment with FP services holds promise for supporting progress toward the UNAIDS 95-95-95 targets for testing, treatment, and prevention. Nonetheless, integration of even basic HIV prevention and treatment services into FP clinics remains low and how best to integrate these services is still unknown. In a previous trial, the Systems Analysis and Improvement Approach (SAIA), was an effective implementation strategy for improving HIV counseling and testing in a small selection of FP clinics in Mombasa County, Kenya when delivered by research staff. SAIA incorporates a cascade analysis tool, sequential process flow mapping, and cycles of micro-intervention development, implementation, and assessment to improve a care cascade. More data is needed to understand if SAIA is effective for also improving linkage to HIV care and screening and linkage to pre-exposure prophylaxis (PrEP) in FP clinics when SAIA is delivered at scale by Kenyan public health workforce. The first objective of this study is to conduct a cluster-randomized trial evaluating the effectiveness of SAIA versus control (usual procedures with no specific intervention) for increasing HIV counseling, testing, linkage to HIV care, and screening and linkage to PrEP in new FP clients and new and returning AGYW clients. There will be a particular focus on the HIV prevention and treatment of AGYW in this study and any AGYW presenting for FP care will be prioritized. Quantitative and qualitative data will be analyzed using the RE-AIM framework to evaluate the program’s Reach, Effectiveness, Adoption, Implementation, and Maintenance. To understand how SAIA could be integrated into national Ministry of Health policies and programs, activity-based costing will be conducted to estimate the budget and program impacts of SAIA, scaled to a County level, from a Ministry of Health perspective. It is hypothesized that compared to control, SAIA will be effective at increasing HIV counseling, HIV testing, linkage to HIV care, and screening and linkage to PrEP for new FP clients and all new and returning AGYW FP clients when delivered at scale by Kenyan public health staff. The implementation evaluation, costing, and budget impact analysis will establish a road map for national-level implementation, positioning Kenya as a global leader in integrating FP/HIV services.