Perceptions and Experiences of Integrated Service Delivery Among Women Living with HIV Attending Reproductive Health Services in Kenya: A Mixed Methods Study

Abstract

This is one of the few studies that explores preferences of and experiences with integrated sexual and reproductive health (SRH)-HIV care among users of mainstream family planning and postnatal care services who are women living with HIV (WLWH). This paper reports on the quantitative data from 179 clients attending public sector clinics and from 30 qualitative in-depth interviews with WLHIV in Kenya. Quantitative data show that integration is happening for the vast majority of these clients at their last HIV visit. However, qualitative data show that very often the care received by WLWH is fragmented as providers do not offer multiple same-day appointments for FP and ARV refills. Our study has shown factors that could either prevent or enable receipt of integrated SRH and HIV care for WLWH. To address these factors, management systems need to be able to support providers to make flexible decisions and facilitate better coordination and communication across clinics within facilities.

The Current Status of Research on the Integration of Sexual and Reproductive Health and HIV Services

“…Stewardship and management systems by mid‐level managers for both resources and supporting health providers’ agency, and flexible decision‐making for client‐centered, integrated care, especially for women living with HIV, are essential (Colombini et al. ).…”

“…Motivated staff must initiate more than one service or a client must demand more than one service during a consultation. Evidence from Integra suggests that aside from formal structural changes, building a health-sector workforce with the agency and authority to work flexibly to make decisions, communicate effectively throughout services (and across sectors), and share workloads as part of a team is critical to sustainable programs of integrated SRH-HIV care (Mutemwa et al 2013;Ndwiga et al 2014;Integra Initiative 2015a;Colombini 2016a;Mayhew et al 2017).…”

“…These healthsystems obstacles need to be resolved to enable scale-up and sustainability of cost-effective, integrated service provision (Wilcher et al 2013a;Newmann et al 2015;Mayhew et al 2016). Stewardship and management systems by mid-level managers for both resources and supporting health providers' agency, and flexible decision-making for client-centered, integrated care, especially for women living with HIV, are essential (Colombini et al 2016a).…”

“…; Colombini et al. ). Providers’ attitudes may discourage further fertility and stress condom‐based contraception, resulting in unintended pregnancies (Myer et al.…”

“…Few differences have been detected in reproductive behaviors as a function of HIV sero-status, but substantial proportions (50-90 percent) of women living with HIV continue to have unmet need for family planning and other reproductive health services (Homsy et al 2009;Smee et al 2011;Lindegren et al 2012;Schwartz et al 2012;Wilcher et al 2013a). Qualitative studies show that women living with HIV receive limited and fragmented FP care within their HIV services Colombini et al 2016a). Providers' attitudes may discourage further fertility and stress condom-based contraception, resulting in unintended pregnancies (Myer et al 2010;Warren, Abuya, and Askew 2013;Church et al 2014), which poses serious challenges to successful formulation and implementation of reproductive goals among sero-positive women (Stuart 2009;IATT 2011;Lindegren et al 2012;Newmann et al 2013).…”