The Linked Response: Lessons Emerging from Integration of HIV and Reproductive Health Services in Cambodia

Abstract

A qualitative assessment was made of service provider and user perceptions of the quality of integrated reproductive health services established through a pilot intervention in Cambodia. The intervention aimed to promote pregnant women's HIV testing and general utilization of reproductive health facilities as well as improve the follow-up of HIV-positive women and exposed infants through strengthened referral and operational linkages amongst health facilities/services and community-based support interventions for PLHIV. The study was conducted in one operational district where the intervention was piloted and for comparative purposes in a district where integrated services had yet to be implemented. Service providers in the pilot district reported improved collaboration and coordination of services, more effective referral, and the positive impact of improved proximity of HIV testing through integrated local level facilities. Community-based support teams for PLHIV embraced their expanded role, were valued by families receiving their assistance, and were understood to have had an important role in referral, PMTCT follow-up and countering PLHIV stigmatization; findings which underscore the potential role of community support in integrated service provision. Challenges identified included stigmatization of PLHIV by health staff at district hospital level and a lack of confidence amongst non-specialized health staff when managing deliveries by HIV-positive women, partly due to fear of HIV transmission.

Facilitators and barriers in HIV linkage to care interventions

“…Of these, 175 manuscripts were excluded because they did not report on intervention (72), did not examine linkage to care (48), did not report qualitative finding (26), did not focus on PLHIV (5), or were reporting on literature reviews (2) (Table 1). We identified twenty-five manuscripts comprised of twenty-two peer-reviewed articles [18, 19, 21, 37–55], two theses/dissertations [56, 57] and one conference abstract [58] (Figure 1). Among these, seventeen studies were single component interventions [19, 21, 37–42, 45, 47, 49, 50, 53, 54, 56–58] and eight were multiple component interventions [18, 43, 44, 46, 48, 51, 52, 55].…”

“…We identified twenty-five manuscripts comprised of twenty-two peer-reviewed articles [18, 19, 21, 37–55], two theses/dissertations [56, 57] and one conference abstract [58] (Figure 1). Among these, seventeen studies were single component interventions [19, 21, 37–42, 45, 47, 49, 50, 53, 54, 56–58] and eight were multiple component interventions [18, 43, 44, 46, 48, 51, 52, 55]. We identified cross-sectional (16) [18, 19, 39, 41–46, 49–51, 53–55, 58], longitudinal (6) [21, 37, 47, 48, 52, 57], and longitudinal-quantitative parent studies (3) study designs [38, 40, 56].…”

“…Among these, seventeen studies were single component interventions [19, 21, 37–42, 45, 47, 49, 50, 53, 54, 56–58] and eight were multiple component interventions [18, 43, 44, 46, 48, 51, 52, 55]. We identified cross-sectional (16) [18, 19, 39, 41–46, 49–51, 53–55, 58], longitudinal (6) [21, 37, 47, 48, 52, 57], and longitudinal-quantitative parent studies (3) study designs [38, 40, 56]. Twelve studies [18, 37–41, 44, 47, 49–51, 53] were from high-income countries (HIC: USA, UK, Canada), eight [19, 43, 45, 46, 52, 54, 56, 58] from middle-income countries (MIC: South Africa, India, Botswana), and five [21, 42, 48, 55, 57] from low-income countries (LIC: Haiti, Tanzania, Cambodia, Malawi, Kenya).…”

“…We identified cross-sectional (16) [18, 19, 39, 41–46, 49–51, 53–55, 58], longitudinal (6) [21, 37, 47, 48, 52, 57], and longitudinal-quantitative parent studies (3) study designs [38, 40, 56]. Twelve studies [18, 37–41, 44, 47, 49–51, 53] were from high-income countries (HIC: USA, UK, Canada), eight [19, 43, 45, 46, 52, 54, 56, 58] from middle-income countries (MIC: South Africa, India, Botswana), and five [21, 42, 48, 55, 57] from low-income countries (LIC: Haiti, Tanzania, Cambodia, Malawi, Kenya). Overall, 24 studies focused on adults [18, 19, 21, 37–43, 45–58], eight included adolescents (defined as ages 10–19) [21, 37, 44–48, 57], and four included pregnant women [21, 43, 55, 57].…”

“…Ten studies reported feedback about implementation processes [18, 38, 41–43, 46, 51, 54, 55, 57]. Providers discussed how successful implementation of linkage interventions required greater clarity in coordinating referrals for PLHIV between health centers.…”