Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It Into Practice?

McGinn, E; Irani, Laili

doi:10.9745/ghsp-d-19-00192

Cited by 4 publications

(8 citation statements)

References 5 publications

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“…Similar to other African countries [50][51][52][53], there is consensus among stakeholders in Rwanda that HIV and family planning (FP) services should be integrated [54]. The Government of Rwanda strongly supports access to the full range of contraceptive options [55] and provides free therapeutic antiretrovirals (ARV) and PMTCT for HIV [56].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background: When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-tochild transmission (PMTCT). Methods: In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. Results: Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…In summary, although Zambia has strong national policies supporting FP/HIV integration, implementation at the facility level has often been weak. 54 This study found that a systematic model for integrating FP and HIV services was associated with the increased use of effective contraception and dual method use among WLHIV in Zambia and a met need for FP. Findings from this study provide additional support for efforts to continue integrating FP and HIV services to ensure that all WLHIV have access to sexual and reproductive health services that address their fertility needs and desires.…”

Section: Discussionmentioning

confidence: 76%

An Evaluation of an Enhanced Model of Integrating Family Planning Into HIV Treatment Services in Zambia, April 2018–June 2019

Medley

Tsiouris

Pals

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:We designed and implemented an enhanced model of integrating family planning (FP) into existing HIV treatment services at 6 health facilities in Lusaka, Zambia.Methods:The enhanced model included improving FP documentation within HIV monitoring systems, training HIV providers in FP services, offering contraceptives within the HIV clinic, and facilitated referral to community-based distributors. Independent samples of women living with HIV (WLHIV) aged ≥16 years were interviewed before and after intervention and their clinical data abstracted from medical charts. Logistic regression models were used to assess differences in key outcomes between the 2 periods.Results:A total of 629 WLHIV were interviewed preintervention and 684 postintervention. Current FP use increased from 35% to 49% comparing the pre- and postintervention periods (P = 0.0025). Increased use was seen for injectables (15% vs. 25%, P < 0.0001) and implants (5% vs. 8%, P > 0.05) but not for pills (10% vs. 8%, P < 0.05) or intrauterine devices (1% vs. 1%, P > 0.05). Dual method use (contraceptive + barrier method) increased from 8% to 18% (P = 0.0003), whereas unmet need for FP decreased from 59% to 46% (P = 0.0003). Receipt of safer conception counseling increased from 27% to 39% (P < 0.0001). The estimated total intervention cost was $83,293 (2018 USD).Conclusions:Our model of FP/HIV integration significantly increased the number of WLHIV reporting current FP and dual method use, a met need for FP, and safer conception counseling. These results support continued efforts to integrate FP and HIV services to improve women's access to sexual and reproductive health services.

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“…Most often, indicators for two or more services were developed specifically for the study and measured the extent to which those services were delivered jointly. The two most common indicators were variations on (1) testing, screening, or counseling a patient with one condition for the other condition or service need [ 32 – 46 ]; and (2) availability of services on the same day, whether via joint treatment by the same provider or in the same visit by different providers [ 38 , 40 , 41 , 46 – 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Other indicators included variations on (3) internal and external referral practices [ 32 , 41 , 42 , 47 ]; (4) common treatment or counseling spaces [ 41 , 47 , 50 ]; (5) availability or receipt of commodities, equipment, and or medications for two or more conditions [ 38 , 44 , 49 , 50 , 52 , 59 ]; and (6) provider knowledge on two or more services [ 35 , 39 , 52 , 55 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

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Integration measurement and its applications in low- and middle-income country health systems: a scoping review

Neill,

Zia,

Ashraf

et al. 2023

BMC Public Health

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Background Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in low- and middle-income countries (LMICs). Underlying this challenge is a lack of coherent approaches to measure the extent of integration and how this influences desired outcomes. The aim of this scoping review is to identify measurement approaches for integration in LMICs and map them for future use. Methods Arksey and O’Malley’s framework for scoping reviews was followed. We conducted a systematic search of peer-reviewed literature measuring integration in LMICs across three databases and screened identified papers by predetermined inclusion and exclusion criteria. A modified version of the Rainbow Model for Integrated Care guided charting and analysis of the data. Results We included 99 studies. Studies were concentrated in the Africa region and most frequently focused on the integration of HIV care with other services. A range of definitions and methods were identified, with no single approach for the measurement of integration dominating the literature. Measurement of clinical integration was the most common, with indicators focused on measuring receipt of two or more services provided at a single point of time. Organizational and professional integration indicators were focused on inter- and intra-organizational communication, collaboration, coordination, and continuity of care, while functional integration measured common information systems or patient records. Gaps were identified in measuring systems and normative integration. Few tools were validated or publicly available for future use. Conclusion We identified a wide range of recent approaches used to measure integration in LMICs. Our findings underscore continued challenges with lack of conceptual cohesion and fragmentation which limits how integration is understood in practice.

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Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It Into Practice?

Cited by 4 publications

References 5 publications

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

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

An Evaluation of an Enhanced Model of Integrating Family Planning Into HIV Treatment Services in Zambia, April 2018–June 2019

Integration measurement and its applications in low- and middle-income country health systems: a scoping review

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