Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Abstract

Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster randomized controlled design, we conducted a formative assessment in two districts in Uganda where community health workers, called VHTs, already offered FP. Thirty-six trained VHTs also provided HIV testing and counseling (HTC) during the intervention. We surveyed all 36 VHTs and 256 FP clients, and reviewed service statistics. In the intervention group, VHTs tested 80% of surveyed clients for HIV, including 76% they already saw for FP and 22% who first came to them for HTC before receiving FP. Comparing clients' experiences in the intervention and control groups, adding HTC does not appear to have negatively affected FP service quality. VHTs reported more monthly clients, but rated their workload as easy to manage. This integrated model seems feasible and beneficial for both VHTs and clients, while not resulting in any negative effects. This study was registered with ClinicalTrials.gov, number [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).Keywords: family planning, HIV, community health workers, integration, Uganda RésuméPeu d'informations sont disponibles sur l'intégration des services de planification familiale (PF) et du VIH dans les milieux communautaires. En utilisant un plan randomisé contrôlé par grappes, nous avons mené une évaluation formative dans deux districts en Ouganda dans lesquels les agents de santé communautaire qui sont appelés VHT offraient déjà des services de PF. Trente-six VHT formés ont également fourni des services de conseil et dépistage du VIH (CDV). Nous avons enquêté les 36 ASC et 256 clientes PF, et nous avons examiné les statistiques sur les services. Dans le groupe d'intervention, les VHT ont testé 80% des clients enquêtées pour le VIH, y compris 76% que les VHT voyaient déjà pour la PF et 22% qui sont d'abord venus pour le CDV avant avant de recevoir la PF. En comparant les expériences des clientes dans les groupes avec et sans intervention, l'ajout du CDV ne semble pas avoir affecté négativement la qualité des services PF. Les VHT ont signalé plus de clients mensuellement, mais ont évalué leur charge de travail comme étant aussi facile à gérer. Ce modèle intégré semble faisable et bénéfique pour les VHT et les clients, et sans entraîner d'effet négatif. Cette étude a été enregistrée auprès de ClinicalTrials.gov, numéro [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).

<p>Integrating HIV and Family Planning Services: The Pros and Cons</p>

“…7,9 Besides educating individual clients, all service providers, programme officers such as health promotion officers and programme managers should be responsible to educate the community about the advantages of an integrated health service. 4 However, it is a proven fact that waiting times in healthcare facilities impact on client satisfaction and, therefore, the effective utilization of integrated services. 14 Contrary to this study, the waiting time to receive the integrated family planning and HIV services is reasonable; 15 a longer waiting time would have a negative effect on the intention to use an integrated HIV and family planning service.…”

Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

“…Centers that provide integrated services report that clients vastly prefer this model [24,25]. Integration models have added FP counseling and methods for patients in HIV care clinics [26][27][28][29][30] and conversely provided HIV testing and referral to FP clients [31][32][33]. However, historical, philosophical and structural differences in the fields of FP and HIV pose obstacles to integration both in the United States and developing countries [34].…”

Uganda Mountain Community Health System Perspectives and Capacities Towards Emerging Infectious Disease Surveillance

“…Some VHTs are recruited by their peers even when they do not have capacities to undertake disease surveillance tasks. Studies have indicated that recruitment of VHTs is not formal and often undermines their performance [56][57][58][59]. No participation of VHTs in reporting of wildlife/animal related disease and environmental events as indicated this study provides an opportunity for diseases to escalate and spillover to humans from livestock and wildlife.…”