Acceptability and Effectiveness of Linking HIV-Positive Family Planning Clients to Treatment and Care Services among Health Care Providers in Kenya

Abstract

Although there has been growing interest in the provision of integrated reproductive health and HIV services in sub-Saharan Africa in recent decades, there is limited evidence on effectiveness of linking family planning clients who test HIV-positive to comprehensive care centers with respect to such outcomes as uptake of care and support services as well as initiation of clients to antiretroviral therapy for those eligible. This paper examined the acceptability and effectiveness of linking HIV-positive family planning (FP) clients to treatment and care services among health care providers in Kenya. Data are from a pre- and post-intervention study without a comparison group. Intervention activities included modifying the referral system, reviewing and updating training materials and job aids, training service providers on the updated tools, and conducting support supervision. Data collection involved facility assessment, provider interviews, and record reviews. Analysis entails descriptive statistics including frequencies, percentages and scores with significant tests of means and proportions to determine if there were any significant differences between baseline and endline. The results show that although most facilities were not adequately prepared in terms of infrastructure to support linking HIV-positive family planning clients to treatment and care services, there was significant improvement in provider acceptance of referral practices after than before the interventions. For example, the proportion of providers who used a directory for referral rose from 8% at baseline to 58% at endline (p<0.01) while the proportion of providers who discussed referral of HIV-positive FP clients improved from 71% at baseline to 96% at the endline (p<0.05). In addition, whereas there was initially no referral of HIVpositive FP clients to comprehensive care centers (CCCs), most of the HIV-positive FP clients received at CCCs (93%) were from within the Maternal-Child-Health (MCH)/FP unit of the same facility during the intervention period indicating that the referral system was effective.