INTEGRATING Sexual & Reproductive Health and HIV Services. www.aids2010.org. OVERVIEW & REVIEW OF EVIDENCE Susannah Mayhew, Kathryn Church, Manuela Colombini Acknowledgements: Aagje Papineau-Salm, Lydia Mungherera, Ron MacInnis. Background.
OVERVIEW & REVIEW OF EVIDENCE
Susannah Mayhew, Kathryn Church,
Acknowledgements: Aagje Papineau-Salm,
Lydia Mungherera, Ron MacInnis
How do these fit into a PHC context?
Recent review on impact of integrating HIV & STI services into FP contexts (Church & Mayhew 2008):1. Integration into SRH services
“there was no planning whatsoever with any of them, it would happen by accident, and it’s like I woke up and I had 13 children and couldn’t do anything about it” (male client, ART clinic Swaziland, INTEGRA project)
I haven’t told anyone [about my status] I only tell those that I find at the clinic when I go collect my pills, they talk about their situations and I also find myself sharing mine, but when it comes to my family, its still a challenge. (female client ) facility-level integrated site
Qualitative interviews with 15 providers and 22 clients at 4 HIV clinics
HIV client exit survey (cross-sectional) with 611 HIV patients
(ACQUIRE Project, 2008; Adamchak, 2007; Hayford, 2009)
Definition: what do we mean by integrated services? Is a good referral system sufficient? Should 1 person do it all? What are ‘linkages’ ?
Differing service configurations: differ from clinic to clinic, town to town, region to region, country to country : how to formulate policy advice?
Health systems challenges: staffing shortages; health worker management systems (rotation); space constraints; logistics systems derived from vertical programmes; management & supervision; weak referral systems
Cultural challenges: client expectations; provider attitudes and expectations; cultures of practice within medical systems (task-orientation and specialism culture); challenges shifting to client-centred care
Technical challenges: skills training – how much can multi-purpose health workers be expected to learn or do?
Donors and funding streams: national & international policies may necessarily still be disease-specific, but leads to separate training, skills specialisation, and programme activities in clinics
IPPF, LSHTM and Population Council-Nairobi The Integra projectAssessing the benefits & costs of different models of integration of HIV and SRH services in Swaziland, Kenya and Malawi 2008-2012. Aims: (a) determine the benefits of different integrated models; (b) determine the impact of different integrated services on changes in HIV risk-behaviour; HIV related stigma and unintended pregnancies; (c) establish the efficiency& cost-effectiveness of using different operational models for delivering integrated services; (d) ensure utilization of research findings by policy and program decision makers through extensive stakeholder involvementContact:[email protected] or [email protected]