HIV and family planning service integration and voluntary HIV counselling and testing client composition in Ethiopia

Abstract

Integrating voluntary HIV counselling and testing (VCT) with family planning and other reproductive health services may be one effective strategy for expanding VCT service delivery in resource poor settings. Using 30,257 VCT client records with linked facility characteristics from Ethiopian non-governmental, non-profit, reproductive health clinics, we constructed multi-level logistic regression models to examine associations between HIV and family planning service integration modality and three outcomes: VCT client composition, client-initiated HIV testing and client HIV status. Associations between facility HIV and family planning integration level and the likelihood of VCT clients being atypical family planning client-types, versus older (at least 25 years old), ever-married women were assessed. Relative to facilities co-locating services in the same compound, those offering family planning and HIV services in the same rooms were 2-13 times more likely to serve atypical family planning client-types than older, ever-married women. Facilities where counsellors jointly offered HIV and family planning services and served many repeat family planning clients were significantly less likely to serve single clients relative to older, married women. Younger, single men and older, married women were most likely to self-initiate HIV testing (78.2 and 80.6% respectively), while the highest HIV prevalence was seen among older, married men and women (20.5 and 34.2% respectively). Compared with facilities offering co-located services, those integrating services at room- and counsellor-levels were 1.9-7.2 times more likely to serve clients initiating HIV testing. These health facilities attract both standard material and child health (MCH) clients, who are at high risk for HIV in these data, and young, single people to VCT. This analysis suggests that client types may be differentially attracted to these facilities depending on service integration modality and other facility-level characteristics.

Factors affecting voluntary HIV counselling and testing among men in Ethiopia: a cross-sectional survey

“…Thus, it is positive that our study found that higher proportions of rural men in this age group had been tested. The higher test proportion found among younger than older rural men was in line with findings from other studies in SSA [11,13,16,48]. The association with younger age that remained after adjustment for education, marital status, knowledge, and sexual behaviour probably reflects the fact that older rural men have a lower self-perceived risk of HIV, but we had not information about this predictor [11].…”

Quantifying and addressing losses along the continuum of care for people living with HIV infection in sub‐Saharan Africa: a systematic review

“…Interventions to increase HIV testing include task-shifting (testing through lay healthcare workers) [77–79] and provider-initiated testing [89–91] as well as mobile, community, home-based and workplace services 83–87,92] which bring the service nearer to the patient and thus increase accessibility, which might in turn increase acceptability. Other interventions aimed to increase acceptability of testing are self-testing [80] and incentivized testing [93,94].…”

Syphilis Screening among 27,150 Pregnant Women in South Chinese Rural Areas Using Point-of-Care Tests

“…Integrating syphilis screening with family planning services, such as intrauterine device insertions, also represents another way of reaching older women. HIV testing has been successfully integrated with post-abortion and other family planning services in settings in Kenya [41], Ethiopia [42], Tanzania [43], and the U.S. [44] …”