REacH is a randomized-controlled study consisting of two experimental models of integrated family planning and HIV services in Zambia.
In Zambia, family planning services and HIV prevention and care have traditionally been provided as separate, stand-alone services. This has resulted in gaps in care for clients and missed opportunities to prevent unintended pregnancies and new HIV infections. Uptake of potentially beneficial services such as voluntary medical male circumcision and long-acting, reversible contraception has not met national goals. Further, Zambia’s primary-care facilities have difficulty tracking and following up with HIV-positive clients, which may result in lower uptake of life-saving antiretroviral therapy and diminished adherence to it.
To address these challenges, the Government of Zambia is seeking to identify the most cost-efficient and effective mix of integrated family planning and HIV services that could have a significant impact on public health and be feasible when implemented at scale. Population Services International (PSI) and its Zambian affiliate, the Society for Family Health (SFH), in collaboration with the Population Council, are evaluating two experimental service models of integrated HIV and family planning services to determine which model is more cost-efficient and effective.
Collaborating with PSI/SFH, the Population Council is conducting a randomized-controlled evaluation to compare the incremental costs and resulting uptake of health services provided by two experimental models of family planning/HIV service integration. Study recruitment began in December 2013.
Clients who access services and voluntarily enroll at three sites located in each of two urban districts with high HIV prevalence will be randomly assigned to one of three groups, two experimental and one control. The experimental groups combine family planning, voluntary medical male circumcision, and HIV testing and counseling services and employ a client referral system, but differ in the level of follow-up provided to clients:
- The first experimental group: Clients randomized to this group at each study site will receive comprehensive provider-initiated assessment, counseling, and referrals for relevant add-on services. Components will include standardized assessment of need, dedicated counseling time and materials, motivational interviewing, standardized referral, and follow-up with clients.
- The second experimental group: Clients in this study group will receive all the components of the first experimental group, but will have the added option of being escorted immediately to the referral service site.
- The control group: Clients randomized to the control group will receive the existing standard of care for HIV testing and counseling, family planning, and/or voluntary medical male circumcision services offered at the study sites.
The results of the study will help the Zambian government and other implementing partners working in Zambia to identify and implement the most effective mix of strategies for integration of family planning and HIV services that can be provided in the country’s private and public health services sites.