Overview and Objectives
The Integra Initiative was research project on the benefits and costs of a range of models for delivering integrated HIV and SRH services in high and medium HIV prevalence settings, to reduce HIV infection (and associated stigma) and unintended pregnancies.
Integration is different kinds of SRH and HIV services or operational programmes that can be joined together to ensure and perhaps maximize collective outcomes. This can include referrals from one service to another. It is based on the need to offer comprehensive and integrated services.
During the five year project, four different models of integrated SRH and HIV services were evaluated in ‘real world’ settings in Kenya, Malawi, and Swaziland.
Findings from the project show that integrating HIV and SRH services has the potential to:
✔ Increase uptake of health services
✔ Increase range of services available
✔ Improve quality of services and efficient use of resources
✔ Enable health systems to respond to client needs and improve overall client satisfaction
1. To determine the benefits of four different models of integration to increase the range, uptake and quality of selected SRH and HIV services.
2. To determine the impact of different integrated services on changes in HIV risk behaviour, HIV-related stigma, and unintended pregnancies.
3. To assess the efficiency of different operational models for delivering integrated services in terms of cost, use of existing infrastructure and human resources.
4. To increase the use of research findings by policy and programme decision-makers through the involvement of key stakeholders.
A ‘programme science’ approach was adopted to study integration in the ‘real world’ setting of health facilities in Kenya, Malawi, and Swaziland. This approach meant that the research was embedded within the day-to-day activities of the health facilities being studied. Integrated services have been available in a variety of forms in Kenya, Malawi, and Swaziland for some time, and at the outset of the initiative, selected facilities received support to strengthen the integration of their services.
In Kenya and Swaziland, these were then matched with comparison facilities that provided some level of integrated services but did not receive support from the initiative. In Malawi, the focus was on operations research evaluating integrated youth-friendly services. A study of the costs, savings, and possible efficiency gains from integrating SRH and HIV services was also conducted in the three countries.
The four models for evaluation:
Model 1: Integrated family planning model (Kenya). Integration of HIV counselling and testing, sexually transmitted infection (STI) screening and management, cervical cancer screening, and condom promotion within family planning consultations, as well as active referral to antiretroviral therapy units for HIV-positive clients.
Model 2: Integrated post-natal care model (Kenya and Swaziland). Integration of family planning services, repeat HIV testing for mother, HIV testing for infant, and referral to HIV services for HIV-positive women with post-natal care for mother and infant.
Model 3: Integrated SRH services (Kenya, Malawi, and Swaziland). Includes family planning, maternal and child health services, HIV testing, HIV care, STI services, cervical cancer screening, and services for youth.
Model 4: Comparison of integrated and stand-alone HIV service models (Swaziland). Comparison of facilities offering fully integrated SRH/HIV services with facilities offering stand-alone HIV services.