Integration of HIV prevention into Sexual and Reproductive Health Services in an urban setting in South Africa

Parker, Shireen; Scott, Vera

doi:10.4102/phcfm.v5i1.522

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…However, there are still many missed opportunities, and many mothers and babies leave the clinic without essential lifesaving information, confirming the notion that integration of services is difficult to achieve, scale up and sustain. [24][25] Various studies suggest that integrated healthcare services are more cost-effective than fragmented services due to economies of scope and scale, are time saving for patients, and contribute to the long-term outcome of healthier communities. [26][27][28][29] However, cost benefits of integration depend on the model of integration used and this needs to be tested at scale.…”

Section: Discussionmentioning

confidence: 99%

Integrating services for impact and sustainability: a proof-of-concept project in KwaZulu-Natal, South Africa

Haskins

Phakathi

Grant

et al. 2019

South African Family Practice

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Background: Integration of services in primary health care settings can provide mother/baby pairs with all required services at one visit. This study aimed to evaluate a proof of concept, quality improvement (QI) intervention to strengthen well-child service provision and integration with maternal health services in five rural clinics in KwaZulu-Natal, South Africa. Methods: Quantitative cross-sectional surveys were conducted among mothers bringing their child for well-child services, before and after implementation of the intervention. Exit interviews and reviews of the child's Road to Health Booklet (RTHB) were conducted to determine services provided at the visit, and the time spent in the clinic was observed and recorded. Results: A total of 413 exit interviews and record reviews were conducted (123 at baseline and 290 at follow-up). At follow-up, significantly more mothers were tested for HIV during the well-child visit (9.2% vs. 22.6%; p = 0.045) and significantly more mothers received ART (3.7% vs. 35.5%; p = 0.010). However, coverage of growth-monitoring services remained low and there was no difference in infant feeding advice provided to mothers at baseline and follow-up (49.5% vs. 49.7%; p = 0.996). More mothers interacted with a registered nurse at follow-up than at baseline (35.8% vs. 80.7%; p = 0.032). Conclusions: Over the implementation period of the QI intervention, improvement was shown in coverage and quality of some maternal health and HIV services, but there was no improvement in growth monitoring. This suggests that QI has the potential to improve integration of service delivery, but this was a small study and further research is recommended.

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Section: Discussionmentioning

confidence: 99%

Integrating services for impact and sustainability: a proof-of-concept project in KwaZulu-Natal, South Africa

Haskins

Phakathi

Grant

et al. 2019

South African Family Practice

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“…Patients want an organised coordinated service, where the number of visits to the facility, and the number of stages in a visit, are minimised to reduce waiting times. 23 Although integration can mean different things to different people, and may require different models in different settings, the basic premise of easily accessible, continuous and comprehensive care remains a common thread. However, integration of services has been difficult to achieve, scale up and sustain.…”

Section: Discussionmentioning

confidence: 99%

Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

Haskins

Phakathi

Grant

et al. 2016

Afr. j. prim. health care fam. med.

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BackgroundIn South Africa, coverage of services for mothers and babies in the first year of life is suboptimal despite high immunisation coverage over the same time period. Integration of services could improve accessibility of services, uptake of interventions and retention in care.AimThis study describes provision of services for mothers and babies aged under 1 year.SettingPrimary healthcare clinics in one rural district in KwaZulu-Natal, South Africa.MethodsAll healthcare workers on duty and mothers exiting the clinic after attending well-child services were interviewed. Clinics were mapped to show the route through the clinic taken by mother–baby pairs receiving well-child services, where these services were provided and by whom.ResultsTwelve clinics were visited; 116 health workers and 211 mothers were interviewed. Most clinics did not provide comprehensive services for mothers and children. Challenges of structural layout and deployment of equipment led to fragmented services provided by several different health workers in different rooms. Well-child services were frequently provided in public areas of the clinic or with other mothers present. In some clinics mothers and babies did not routinely see a professional nurse. In all clinics HIV-positive mothers followed a different route. Enrolled nurses led the provision of well-child services but did not have skills and training to provide comprehensive care.ConclusionsFragmentation of clinic services created barriers in accessing a comprehensive package of care resulting in missed opportunities to provide services. Greater integration of services alongside immunisation services is needed.

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“…Accepting the complexity of sexual activities and the associated risks highlights the need for the integration of HIV prevention with SRH (Parker and Scott 2013), including the elements of contraception, pregnancy-related care, STIs, and broader issues of sexual violence and cervical cancer (Stevens 2009). An investment in SRH services and education has far-reaching benefits including social and gender equality, and better education outcomes (Singh, Darroch and Ashford 2014).…”

Section: Lessons From Interventionsmentioning

confidence: 99%

Promoting students’ sexual and reproductive health in peer-led programmes at two South African universities: Emergent tensions and dilemmas

Riet

Akhurst

Wilbraham

2019

sajhe

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Sexual and reproductive health programmes with students in higher education in South Africa, are a neglected area of intervention. We report on piloting the peer-facilitated Auntie Stella intervention material at two South African universities. This participatory methodology encourages critical thinking by opening discussion on managing relationships, sexual decision-making, gender-based violence and risk-safety. The format involves cards featuring a letter, a facilitated discussion, an answer-response and possible action points. Six focus groups of participants were facilitated by postgraduate students over four months. Using thematic analysis four tensions were identified in the student discussions: HIV awareness was in tension with relationship practices; awareness of risk was in tension with denial of vulnerability; awareness of individuals' rights was in tension with claims on these rights; and HIV knowledge was in tension with HIV stigma. The Auntie Stella material has the potential to open up discursive spaces amongst students, and to develop agency in sexual decision-making.

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Integration of HIV prevention into Sexual and Reproductive Health Services in an urban setting in South Africa

Cited by 4 publications

References 17 publications

Integrating services for impact and sustainability: a proof-of-concept project in KwaZulu-Natal, South Africa

Integrating services for impact and sustainability: a proof-of-concept project in KwaZulu-Natal, South Africa

Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

Promoting students’ sexual and reproductive health in peer-led programmes at two South African universities: Emergent tensions and dilemmas

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