Study protocol for the Integra Initiative to assess the benefits and costs of integrating sexual and reproductive health and HIV services in Kenya and SwazilandReportar como inadecuado

Study protocol for the Integra Initiative to assess the benefits and costs of integrating sexual and reproductive health and HIV services in Kenya and Swaziland - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Public Health

, 12:973

Health policies, systems and management in high-income countries


BackgroundIn sub-Saharan Africa SSA there are strong arguments for the provision of integrated sexual and reproductive health SRH and HIV services. Most HIV transmissions are sexually transmitted or associated with pregnancy, childbirth, and breastfeeding. Many of the behaviours that prevent HIV transmission also prevent sexually transmitted infections and unintended pregnancies. There is potential for integration to increase the coverage of HIV services, as individuals who use SRH services can benefit from HIV services and vice-versa, as well as increase cost-savings. However, there is a dearth of empirical evidence on effective models for integrating HIV-SRH services. The need for robust evidence led a consortium of three organizations – International Planned Parenthood Federation, Population Council and the London School of Hygiene and Tropical Medicine – to design-implement the Integra Initiative. Integra seeks to generate rigorous evidence on the feasibility, effectiveness, cost and impact of different models for delivering integrated HIV-SRH services in high and medium HIV prevalence settings in SSA.

Methods-designA quasi-experimental study will be conducted in government clinics in Kenya and Swaziland – assigned into intervention-comparison groups. Two models of service delivery are investigated: integrating HIV care-treatment into 1 family planning and 2 postnatal care. A full economic-costing will be used to assess the costs of different components of service provision, and the determinants of variations in unit costs across facilities-service models. Health facility assessments will be conducted at four time-periods to track changes in quality of care and utilization over time. A two-year cohort study of family planning-postnatal clients will assess the effect of integration on individual outcomes, including use of SRH services, HIV status known-unknown and pregnancy planned-unintended. Household surveys within some of the study facilities’ catchment areas will be conducted to profile users-non-users of integrated services and demand-receipt of integrated services, before-and-after the intervention. Qualitative research will be conducted to complement the quantitative component at different time points. Integra takes an embedded ‘programme science’ approach to maximize the uptake of findings into policy-practice.

DiscussionIntegra addresses existing evidence gaps in the integration evaluation literature, building on the limited evidence from SSA and the expertise of its research partners.

Trial registrationCurrent Controlled Trials NCT01694862

KeywordsSexual and reproductive health HIV services Integration Sub-Saharan Africa Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-12-973 contains supplementary material, which is available to authorized users.

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Autor: Charlotte E Warren - Susannah H Mayhew - Anna Vassall - James Kelly Kimani - Kathryn Church - Carol Dayo Obure - Natalie


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