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Chen Y, Begnel E, Muthigani W, Achwoka D, Mcgrath CJ, Singa B, Gondi J, Ng'ang'a L, Langat A, John-Stewart G, Kinuthia J, Drake AL. Higher contraceptive uptake in HIV treatment centers offering integrated family planning services: A national survey in Kenya. Contraception 2020; 102:39-45. [PMID: 32298715 DOI: 10.1016/j.contraception.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Integrating family planning (FP) into routine HIV care and treatment are recommended by WHO guidelines to improve FP access among HIV-infected individuals in sub-Saharan Africa. This study sought to assess factors that influence the delivery of integrated FP services and the impact of facility-level integration of FP on contraceptive uptake among women living with HIV (WLWH). STUDY DESIGN A national cross-sectional study was conducted among WLWH at HIV Care and Treatment centers with >1000 antiretroviral treatment (ART) clients per year. A mobile team visited 108 HIV Care and Treatment centers and administered surveys to key informants regarding facility attributes and WLWH regarding FP at these centers between June and September 2016. We classified facilities offering FP services within the same facility as 'integrated' facilities. RESULTS 4805 WLWH were enrolled at 108 facilities throughout Kenya. The majority (73%) of facilities offered integrated FP services. They were more likely to be offered in public than private facilities (Prevalence Ratio [PR]: 1.86, 95% Confidence Interval [CI]: 1.11-3.11; p = 0.02] and were more common in the Nyanza region than the Nairobi region (77% vs 35% respectively, p = 0.06). Any contraceptive use (89% vs 80%), use of modern contraception (88% vs 80%), dual method use (40% vs 30%), long-acting reversible contraception (LARC) (28% vs 20%), and non-barrier short-term methods (34% vs 27%) were all significantly higher in facilities with integrated FP services (p < 0.001). CONCLUSIONS The majority of high volume facilities integrated FP services into HIV care. Integrating FP services may increase modern contraceptive use among WLWH. IMPLICATIONS Integration of FP services was associated with higher modern contraceptive use, lower unmet need for modern methods and higher use of long-acting, reversible contraception (LARC), and non-barrier short-term methods among women living with HIV. Despite high prevalence of integration of FP services, organizational challenges remain at integrated clinics.
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Affiliation(s)
- Yilin Chen
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Emily Begnel
- Department of Global Health, University of Washington, Seattle, WA, USA; Kenya Research and Training Center, University of Washington, Seattle, WA, USA
| | - Wangui Muthigani
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Dunstan Achwoka
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | | | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Joel Gondi
- Reproductive and Maternal Health Service Unit, Ministry of Health, Nairobi, Kenya
| | - Lucy Ng'ang'a
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Agnes Langat
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA.
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Mazur A, Brindis CD, Decker MJ. Assessing youth-friendly sexual and reproductive health services: a systematic review. BMC Health Serv Res 2018; 18:216. [PMID: 29587727 PMCID: PMC5870922 DOI: 10.1186/s12913-018-2982-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last quarter century, there has been an emergence of evidence-based research directed toward the development, implementation, and assessment of youth-friendly health services (YFHS) to improve the delivery of sexual and reproductive health services for young people. Despite these research efforts, evidence supporting the effectiveness of YFHS is limited, which may be attributed to a lack of consensus on how to define and measure youth-friendliness to track progress and evaluate outcomes. The purpose of this systematic review is to assess how youth-friendly sexual and reproductive health services are measured worldwide. METHODS We conducted a systematic review of studies measuring youth-friendly sexual and reproductive health services at health facilities published between January 2000 and June 2015 using PubMed, Web of Science, and POPLINE databases. Additional studies were identified by reviewing references of selected articles. Studies were screened to identify measurements and indicators that have been used to measure YFHS. RESULTS Our review identified 20 studies from an initial search of more than 11,000 records, including six from high-income countries and 14 from low-and middle-income countries. The review identified 115 indicators used for measuring youth-friendly sexual and reproductive health services. Our review found a lack of consistency in the tools and indicators used to measure YFHS. The three most frequently assessed domains were accessibility, staff characteristics and competency, and confidentiality and privacy. The majority of the indicators were not specific to young people's needs and often reflected basic standards of care. CONCLUSIONS This review shows the need for standardization and prioritization of indicators for the evaluation of YFHS. The results can be used to identify a core set of indicators that can be incorporated into a framework for assessing youth-friendly sexual and reproductive health services. There is a need to further distinguish between those variables that may have greatest impact on the use of services by young people, such as respect and privacy, those that impact the quality of services offered, and those that have limited relevance. Conducting more rigorous studies using a refined set of indicators is critical to measure and compare the impact and effectiveness of YFHS efforts.
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Affiliation(s)
- Amanda Mazur
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
- Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94143-0503 USA
| | - Martha J. Decker
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
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Increasing HIV testing among African immigrants in ireland: challenges and opportunities. J Immigr Minor Health 2016; 17:89-95. [PMID: 24549490 DOI: 10.1007/s10903-014-9986-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In 2012, immigrants constitute 63% of new cases of heterosexually transmitted HIV among individuals born outside Ireland. Current strategies to encourage testing can be ineffective if immigrants perceive them as culturally insensitive. We obtained qualitative data to explore challenges to voluntary HIV-testing for immigrants in Ireland. Content analysis was undertaken to identify and describe pertinent themes. Widespread beliefs that HIV is primarily a disease of African immigrants were identified as challenges that constrain access to testing and care. The organization and location of testing services, attitude of health workers, and beliefs regarding mandatory HIV-testing for immigrants seeking access to welfare benefits were also identified. Immigrants in Ireland encounter a variety of structural, cultural and personal constraints to HIV testing. Opportunities exist in the Irish Health system to increase testing among immigrants through greater acknowledgement of cultural sensitivities of immigrant groups.
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Michaels-Igbokwe C, Lagarde M, Cairns J, Terris-Prestholt F. Designing a package of sexual and reproductive health and HIV outreach services to meet the heterogeneous preferences of young people in Malawi: results from a discrete choice experiment. HEALTH ECONOMICS REVIEW 2015; 5:9. [PMID: 25984434 PMCID: PMC4424232 DOI: 10.1186/s13561-015-0046-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 03/06/2015] [Indexed: 05/05/2023]
Abstract
BACKGROUND This article examines young people's preferences for integrated family planning (FP) and HIV services in rural Malawi. Different hypothetical configurations for outreach services are presented using a Discrete Choice Experiment (DCE). Responses are analysed using Random Parameters Logit and Generalised Mixed Logit (GMXL) models in preference space and a GMXL model parameterised in willingness-to-pay space. Simulations are used to estimate the proportion of respondents expected to choose different service packages as elements are varied individually and in combination. RESULTS Responses were collected from 537 young people aged 15-24. Results show that when considering attending an outreach service to access family planning young people value confidentiality and the availability of HIV services including HIV counselling and testing (HCT) and HIV treatment, though significant observable and unobservable heterogeneity is present. Female respondents and those aged 20-24 were less concerned with service confidentiality compared to male respondents and those aged 15-19; respondents who were in a relationship at the time of the survey valued confidentiality more than those who reported being single. The addition of sports and recreation for young people may also be an attractive feature of a youth-friendly service; however, preferences for this attribute vary according to respondent gender. Results of the simulation modelling indicate that the most preferred service package is one that offers confidential services, both HCT and HIV treatment and sports for youth, with up to 32% of respondents expected to choose this service over a service where clients may have concerns over confidentiality, only HCT is available and there are no additional activities for young people. Estimates of willingness-to-pay for service attributes indicate that respondents were willing to pay up to USD$1.76 for confidentiality, USD$0.65 for a service offering both HCT and HIV treatment and USD$0.26 for a service including sports for youth. CONCLUSIONS Young people were able to complete a complex DCE and appeared to trade between the different characteristics used to describe the outreach services. These findings may offer important insight to policy makers designing youth friendly SRH outreach services and providers aiming to improve the acceptability and uptake of FP services.
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Affiliation(s)
- Christine Michaels-Igbokwe
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Mylene Lagarde
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH UK
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Health Services Research and Policy, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - John Cairns
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Health Services Research and Policy, 15-17 Tavistock Place, London, WC1H 9SH UK
| | | | - Fern Terris-Prestholt
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH UK
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Abstract
INTRODUCTION Increasing access to contraception among women who enter the health system for HIV care is crucial to help them achieve their fertility intentions and reduce vertical transmission of HIV. Identifying intervention strategies that contribute to effective family planning/HIV service integration and synthesizing lessons for future integration programming and research is important to move the field forward. METHODS Using a standard review methodology, we searched for articles in the peer-reviewed literature published between January 2008 and August 2013 that addressed the integration of family planning interventions into HIV service settings. Eligible studies were assessed in terms of methodological rigor; documented outcomes; and reported process and cost data. RESULTS Twelve studies met our inclusion criteria. Eight studies documented significant increases in contraceptive use by HIV service clients, and three reported significant increases in completed referrals from HIV services to family planning clinics. The outcomes of the seven studies implemented in public sector facilities were more modest than the five studies embedded in clinical trials. Process evaluation measures for some of the studies indicated weak implementation of the intervention as intended. The average rigor score was low, 3.4 out of 9. CONCLUSION Our review reveals an expanding evidence base for integrated family planning/HIV service delivery innovations. However, the modest observed effect under typical settings and the evidence of weak intervention implementation emphasize the need for stronger programmatic efforts and implementation research to address the health system obstacles to integrating these two essential services.
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