Abstract
The lack of human resources is a key challenge in scaling up of HIV services in Africa’s health care system. Integrating HIV services could potentially increase their effectiveness and optimize the use of limited resources and clinical staff time. We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload. This study was conducted in 24 health facilities in Kenya under the Integra Initiative, a non-randomized, pre/post intervention trial to evaluate the impact of integrated HIV and sexual and reproductive health services on health and service outcomes. We compared the time spent providing PITC-only services, FP-only services and integrated PITC/FP services. We used log-linear regression to assess the impact of plausible determinants on the duration of clients’ consultation times. Median consultation duration times were highest for PITC-only services (30 min), followed by integrated services (10 min) and FP-only services (8 min). Times for PITC-only and FP-only services were 69.7% higher (95% Confidence Intervals (CIs) 35.8–112.0) and 43.9% lower (95% CIs −55.4 to − 29.6) than times spent on these services when delivered as an integrated service, respectively. The reduction in consultation times with integration suggests a potential reduction in workload. The higher consultation time for PITC-only could be because more pre- and post-counselling is provided at these stand-alone services. In integrated PITC/FP services, the duration of the visit fell below that required by HIV testing guidelines, and service mix between counselling and testing substantially changed. Integration of HIV with FP services may compromise the quality of services delivered and care must be taken to clearly specify and monitor appropriate consultation duration times and procedures during the process of integrating HIV and FP services.
Highlights
Global policy recommendations support the integration of HIV and sexual and reproductive health (SRH) (Kennedy et al 2010; Johnson et al 2012)
We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload
Median consultation duration times were higher: in the intervention compared to the comparison arm (15 vs 7 min); for PITC-only compared with FP-only consultations (30 vs 8 min) and integrated services PITC/FP (10 min); in the Central Region compared to Eastern Region (15 vs 7 min); and in adults only and adult and child (10 min) compared with unknown coded (8 min) (Table 2)
Summary
Global policy recommendations support the integration of HIV and sexual and reproductive health (SRH) (Kennedy et al 2010; Johnson et al 2012). Integration in this context commonly refers to ‘the delivery of different sets of HIV and SRH services within the same setting, during the same hours, and, preferably, under the same roof, or as part of a facilitated referral within the same facility or to off-site facilities’ (Liambila et al 2013). The evidence of the impact of integration on staff workloads, and on consultation duration times, remains unclear
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