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Abstract

Strengthening and scaling up HIV services through integration into family planning: Results from an evaluation 
Presentation at the 2009 HIV/AIDS Implementers' Meeting, Windhoek, Namibia, 10-14 June
Mullick,Saiqa; Mosery,Nzwakie; Menziwa,Mantshi; Khoza,Doctor; Maroga,Edwin
Publication date: 2009


Background and implementation approach
The South African Government's National Strategic Plan (NSP 2007-11) supports integrated services. Counseling and testing for HIV is largely limited to antenatal settings and stand-alone services. This project implemented and evaluated a provider-initiated testing and counseling (PITC) approach within family planning (FP) services in North West Province, South Africa. The Population Council, in collaboration with the National and Provincial Departments of Health, conducted a two-phased evaluation of an intervention aimed at strengthening HIV prevention and testing services through integration into family planning services. The first phase of the project found that FP services are indeed a missed opportunity for HIV integration and that integration of HIV into FP is acceptable and feasible without negatively impacting the existing service. In Phase II a feasible model was further evaluated for effectiveness in improving the uptake of VCT and dual protection. Family planning providers were trained in the Balanced Counseling Strategy Plus (BCS+) approach to consultations. These tools integrate HIV prevention and testing into the family planning consultation.

Analysis design and methods
In Phase II, 12 primary health care clinics were randomized to two groups: six intervention and six comparison clinics. Routine data collection, clinic inventories, client-provider observations, anonymous questionnaires, focus group discussions, and exit interviews were conducted pre- and post-intervention. Quantitative data were analyzed in STATA and qualitative data were analyzed using content analysis.

Results
A total of 1,093 client-provider observations were conducted at baseline and 1,225 at endline; 1,089 client exit interviews were conducted at baseline and 1,264 at endline. Clients were also asked to fill in an anonymous questionnaire asking details on HIV status and current treatment. After the intervention more providers mentioned (69% vs. 32%, p=0.000) in the intervention clinics as compared to control and offered VCT (42% vs. 26%, p=0.000) and a larger proportion of clients in the intervention group decided to have the test (22% vs. 16%, p=0.004). Clients reporting ever having an HIV test improved from 48% to 67% (p=0.000) in the intervention group compared to 58% to 63% (p=0.060) in the control group. Self-reported condom use went up from 32% to 43% (p=0.000) in the intervention group compared to a decline in the control group from 35% to 38% (0.361). Dual protection increased from 47% to 56% (p=0.003) in the intervention group compared to a decline in the control group from 49% to 50% (p=0.716).

Conclusions and recommendations
Integration of HIV prevention and counseling and testing into FP services is an effective strategy to reach a large number of sexually active women and can improve HIV service delivery, client risk, and health-seeking behavior without negatively impacting on the existing quality of FP.