Abstract
BackgroundA high proportion of African women utilize family planning (FP) services. Accordingly, incorporating HIV testing into FP services may strategically target the first WHO 90–90-90 goal of 90% of people living with HIV knowing their status.MethodsThe objective of this analysis was to determine the proportion of new FP clients counseled and tested for HIV, as well as correlates of HIV testing, in a random sample of 58 FP clinics in Mombasa County, Kenya. Structured interviews of FP clinic managers collected data on characteristics of FP clinics and staff. Study staff performed a 3-month review of FP registers, summarizing new client HIV testing and counseling (HTC). Because overall rates of HTC were quite low, a binary variable was created comparing clinics performing any HIV counseling and/or testing to clinics performing none. Generalized linear models were used to calculate prevalence ratios (PR) and identify correlates of HTC. Factors associated with any HTC with a p-value < 0.10 in univariate analysis were included in a multivariate analysis.ResultsOf the 58 FP clinics, 26 (45%) performed any counseling for HIV testing, and 23 (40%) performed any HIV testing. Counseling for HIV testing was conducted for 815/4389 (19%) new clients, and HIV testing was performed for 420/4389 (10%). Clinics without trained HIV testing providers uniformly did not conduct HIV counseling and/or testing (0/12 [0%]), while 27/46 (59%) of clinics with ≥1 provider performed some HTC (p < 0.001). In the subset of 46 clinics with ≥1 trained HIV testing provider, correlates of performing HTC included being a public versus non-public clinic (PR 1.70 95%CI 1.01–2.88), and having an HIV comprehensive care center (CCC) onsite (PR 2.05, 95%CI 1.04–4.06).ConclusionTrained HIV testing providers are crucial for FP clinics to perform any HTC. Approaches are needed to increase routine HTC in FP clinics including staffing changes and/or linkages with other testing services (in standalone VCT services or lab facilities) in order to improve the implementation of existing national guidelines. A future cluster randomized trial is planned to test an implementation strategy, the Systems Analysis and Improvement Approach (SAIA) to increase HTC in FP clinics.
Highlights
A high proportion of African women utilize family planning (FP) services
Brief structured interviews with FP clinics managers collected information about each clinic including size, location, size of population served, public versus private facility, presence of academic or non-governmental organization (NGO) support, what other clinics are co-located with the FP clinic, if the FP clinic holds regular management meetings, and clinic staff characteristics
In conclusion, human immunodeficiency virus (HIV) testing was being conducted in approximately 40% of FP clinics in Mombasa County, despite strong national Kenyan guidelines recommending HIV testing in all FP clients
Summary
A high proportion of African women utilize family planning (FP) services. Incorporating HIV testing into FP services may strategically target the first WHO 90–90-90 goal of 90% of people living with HIV knowing their status. There is a large burden of human immunodeficiency virus (HIV) in African women of childbearing age [1,2,3]. To target the World Health Organization’s first 90–90-90 goal of having 90% of people with HIV knowing their status, improvements in the implementation of HIV testing and counseling (HTC) are needed. Many women in sub-Saharan African access family planning (FP) services [4,5,6,7], including 44% of women in Mombasa County, Kenya. Integrating HIV testing and prevention with FP services is a promising approach to optimizing healthcare delivery, and is supported by the WHO’s Global Health Sector Strategy on HIV 2016–2021 [9, 10]
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