Abstract
This is one of the few studies that explores preferences of and experiences with integrated sexual and reproductive health (SRH)-HIV care among users of mainstream family planning and postnatal care services who are women living with HIV (WLWH). This paper reports on the quantitative data from 179 clients attending public sector clinics and from 30 qualitative in-depth interviews with WLHIV in Kenya. Quantitative data show that integration is happening for the vast majority of these clients at their last HIV visit. However, qualitative data show that very often the care received by WLWH is fragmented as providers do not offer multiple same-day appointments for FP and ARV refills. Our study has shown factors that could either prevent or enable receipt of integrated SRH and HIV care for WLWH. To address these factors, management systems need to be able to support providers to make flexible decisions and facilitate better coordination and communication across clinics within facilities.
Highlights
With the new treatment guidelines recommending earlier ART initiation and all pregnant and breastfeeding women to start lifelong ART [1], millions of women living with HIV (WLWH) begin or continue to get ARVs for their entire reproductive lives [2]
Our study has shown factors that could either prevent or enable receipt of integrated sexual and reproductive health (SRH) and HIV care for WLWH
WLWH who are using family planning (FP) and HIV services within a mainstream setting appreciated the integration of these services
Summary
With the new treatment guidelines recommending earlier ART initiation and all pregnant and breastfeeding women to start lifelong ART [1], millions of WLWH begin or continue to get ARVs for their entire reproductive lives [2]. Many studies and reviews have assessed the effectiveness of the integration of HIV and SRH services, discussing issues around coverage, service uptake and timeto-treatment initiation [7,8,9,10,11,12,13,14], access to quality services [15], providers’ experiences and willingness to deliver joint services [16,17,18,19,20,21,22,23], cost-effectiveness [24, 25], and health systems barriers to integration [2, 3, 26, 27]. Some of the positive gains of integrated care reported by women include increased coverage of HIV testing, improved convenience, efficiency, confidentiality, and increased likelihood of using a family planning
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