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Does integration increase the range and uptake of services by clients?

Summary: Integrating HIV services into family planning and PNC services has improved uptake of HIV counselling and testing at these facilities. Over a two year period, people with greater exposure to integrated facilities had better rates of using HIV counselling & testing services.

Detail: Analysis of the client flow data from the 42 health facilities in Kenya and Swaziland concludes that overall there is no clear increase in uptake of integrated services by clients or the range or services utilised.

The baseline intervention health facilities did show an initial increase in integrated service uptake but this was not sustained over time. This suggests that integration is difficult to sustain, especially during vertical campaigns (e.g. voluntary counselling and testing – VCT), and due to systems level factors including staff rotation between facilities.

The overall proportion of users who received/demanded integrated services was small, but this most commonly took place where HIV counselling was integrated – especially within family planning (FP), antenatal care (ANC) and maternal and child health (MCH) services. Therefore, the best opportunities for scaling-up HIV integration lie within ANC, MCH and family planning, because of their frequent use. However, provision of integrated services is not enough on its own – there must also be creation of demand in order to increase uptake of integrated services.

There were wide variations between clinics in both countries. A small number of clinics did show consistent increases in both range and uptake of services and there should be further analysis to understand what facility level factors contributed to this change.

Findings from the community survey data from Kenya and Swaziland show that between 2009 and 2012 there was a population-level decline in service use, but there was also a decline in need for HIV-STI services and HIV-FP services. In this period, there were reduced levels of missed opportunities for women who used services, which indicates that demands for integrated services were better met. However, there is still a need to increase demand and receipt of integrated services, due to usage of services among men and continued unmet need for FP and other RH services integrated into HIV-STI services.

Additional findings from Kenya and Swaziland suggest that there may be a population level reduction in risk-behaviour, possibly as a result of many years of awareness-raising about risky sexual behaviour.

Further information on the methodology and findings are available from these presentations: