Strengthening integration of family planning with HIV/AIDS and other services: experience from three Kenyan cities

Abstract

Background Kenya has made remarkable progress in integrating a range of reproductive health services with HIV/AIDS services over the past decade. This study describes a sub-set of outcomes from the Bill & Melinda Gates Foundation (BMGF)-funded Jhpiego-led Kenya Urban Reproductive Health Initiative ( Tupange ) Project (2010–2015), specifically addressing strengthening family planning (FP) integration with a range of primary care services including HIV testing and counselling, HIV care services, and maternal, newborn and child care. Methods A cross-sectional study was conducted between August and October 2013 in the cities of Mombasa, Nairobi and Kisumu in Kenya to assess the level of FP integration across six other service delivery areas (antenatal care clinic, maternity wards, postnatal care clinic, child welfare clinic, HIV testing and counseling (HTC) clinics, HIV/AIDS services in comprehensive care clinics). The variables of interest were level of integration, provider knowledge, and provider skills. Routine program monitoring data on workload was utilized for sampling, with additional data collected and analyzed from twenty health facilities selected for this study, along with client exit interviews. Descriptive analysis and Chi-square/ Fishers Exact tests were done to explore relationships between variables of interest. Results Integration of FP occurred in all the five service areas to varying degrees. Service provider FP knowledge in four service delivery areas (HTC clinic, antenatal clinic, postnatal clinic, and child welfare clinic) increased with increasing levels of integration. Forty-seven percent of the clients reported that time spent accessing FP services in the HTC clinic was reasonable. However, no FP knowledge was reported from service providers in HIV/AIDS comprehensive care clinics in all levels of integration despite observed provision of counseling and referral for FP services. Conclusions Integration of FP services in other primary care service areas including HTC clinic can be enhanced through targeted interventions at the facility. A holistic approach to address service providers’ capacity and attitudes, ensuring FP commodity security, and creating a supportive environment to accommodate service integration is necessary and recommended. Additional studies are necessary to identify ways of enhancing FP integration, particularly with HIV/AIDS care services. Electronic supplementary material The online version of this article (10.1186/s12978-019-0715-8) contains supplementary material, which is available to authorized users.

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

“…The literature on HIV-FP integration at the facility-level highlights the importance of structural aspects of service delivery including commodities and reagent stocks, provider knowledge and skills, workload and job satisfaction [ 42 , 43 ]. In Tanzania significant determinants of facility readiness for integrating FP and HIV were being government owned, having routine management meetings, availability of guidelines in-service training of staff and availability of laboratories for HIV testing [ 37 ].…”

“…'Dual method' usecondoms for HIV/STI prevention PLUS a longer-acting method for pregnancy preventionis the best course of action [34], but often condom use is emphasized as an alternative rather than adjunctive method. Lastly, at the facility level, numerous studies confirm that logistical obstacles including under-staffing, lack of space, vertical service silos and sub-optimal training remain major challenges [37][38][39][40][41][42][43][44][45].…”

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

“…It is known that an integrated service can minimize the missed opportunities and allow health workers to provide family planning services and HIV services simultaneously. 15 The integration of HIV and family planning is feasible and has potential positive outcomes, but the success of integration is dependent on the health system factors. 17 It is a cost-effective way with a reasonable waiting time that saves clients time by avoiding repeated visits.…”

“…17 It is a cost-effective way with a reasonable waiting time that saves clients time by avoiding repeated visits. 15 It can also avoid unnecessary visits to healthcare facilities as women can receive family planning as well as HIV services at a one-stop facility. 8 It is essential to address service providers' capacity and attitudes to create a supportive environment to ensure HIV and family planning service integration.…”

“…8 It is essential to address service providers' capacity and attitudes to create a supportive environment to ensure HIV and family planning service integration. 15 Integrating HIV services with family planning services can, therefore, address the family planning needs of people living with HIV. 17 However, there are factors that can affect the integration of HIV and family planning services.…”