The impact of integrated reproductive health and HIV services on HIV testing and counseling (HTC) uptake was assessed among 882 Kenyan family planning clients using a nonrandomized cohort design within six intervention and six “comparison” facilities. The effect of integration on HTC goals (two tests over two years) was assessed using conditional logistic regression to test four “integration” exposures: a training and reorganization intervention; receipt of reproductive health and HIV services at recruitment; a functional measure of facility integration at recruitment; and a woman's cumulative exposure to functionally integrated care across different facilities over time. While recent receipt of HTC increased rapidly at intervention facilities, achievement of HTC goals was higher at comparison facilities. Only high cumulative exposure to integrated care over two years had a significant effect on HTC goals after adjustment (aOR 2.94, 95%CI 1.73-4.98), and programs should therefore make efforts to roll out integrated services to ensure repeated contact over time.
Published in a peer-reviewed journal of the Population Council. Kathryn Church, Isolde Birdthistle, and Keith Tomlin are Assistant Professors, Department of Population Health, London School of Hygiene & Tropical Medicine. Charlotte E. Warren is Senior Associate, Population Council, Washington, DC. George B. Ploubidis is Professor, Centre for Longitudinal Studies, Department of Social Science, University College London. Sedona Sweeney is Research Fellow and Susannah H. Mayhew is Professor, Department of Global Health and Development, London School of Hygiene & Tropical Medicine. Weiwei Zhou is a PhD student, University of Oxford. James Kimani and Charity Ndwiga are Program Officers, and Timothy Abuya is Associate, Population Council, Nairobi.