Integrating Family Planning and HIV Services at the Community Level: Formative Assessment with Village Health Teams in Uganda

Aurélie Brunie, Patricia N. W. Mucheri, Angela Akol, Mario Chen, Sarah J Mercer, Tricia Petruney

Abstract

Little is known on integrating HIV and family planning (FP) services in community settings. Using a cluster randomized controlled design, we conducted a formative assessment in two districts in Uganda where community health workers, called VHTs, already offered FP. Thirty-six trained VHTs also provided HIV testing and counseling (HTC) during the intervention. We surveyed all 36 VHTs and 256 FP clients, and reviewed service statistics. In the intervention group, VHTs tested 80% of surveyed clients for HIV, including 76% they already saw for FP and 22% who first came to them for HTC before receiving FP. Comparing clients‘ experiences in the intervention and control groups, adding HTC does not appear to have negatively affected FP service quality. VHTs reported more monthly clients, but rated their workload as easy to manage. This integrated model seems feasible and beneficial for both VHTs and clients, while not resulting in any negative effects. This study was registered with ClinicalTrials.gov, number [NCT02244398]. (Afr J Reprod Health 2017; 21[2]: 73-80).

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References

WHO. WHO Technical Guidance Note: Strengthening the inclusion of reproductive, maternal, newborn and child (RMNCH) health in concept notes to the Global Fund. Geneva, Switzerland: World Health Organization; 2014.

OGAC. PEPFAR blueprint: Creating an AIDS-free generation. Washington, DC: OGAC; 2012.

Spaulding AB, Brickley DB, Kennedy C, Almers L, Packel L, Mirjahangir J, Kennedy G, Collins L, Osborne K and Mbizvo M. Linking family planning with HIV/AIDS interventions: a systematic review of the evidence. AIDS 2009;23 Suppl 1:S79-88.

Wilcher R, Hoke T, Adamchak SE and Cates Jr W. Integration of family planning into HIV services: a synthesis of recent evidence. AIDS 2013;27:S65-S75.

Kennedy CE, Spaulding AB, Brickley DB, Almers L, Mirjahangir J, Packel L, Kennedy GE, Mbizvo M, Collins L and Osborne K. Linking sexual and reproductive health and HIV interventions: a systematic review. J Int AIDS Soc 2010;13:26.

WHO. Task shifting. Rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: World Health Organization; 2008.

Haines A, Sanders D, Lehmann U, Rowe A, Lawn J, Jan S, Walker D and Bhutta Z. Achieving child survival goals: potential contribution of community health workers. Lancet 2007;369(9579):2121-2131.

Singh P and Sachs JD. 1 million community health workers in sub-Saharan Africa by 2015. Lancet 2013;382(9889):363-365.

Lehmann U, Van Damme W, Barten F and Sanders D. Task shifting: the answer to the human resources crisis in Africa? Hum Resour Health 2009;7(1):49.

Creanga AA, Bradley HM, Kidanu A, Melkamu Y and Tsui AO. Does the delivery of integrated family planning and HIV/AIDS services influence community-based workers‘ client loads in Ethiopia? Health policy and planning 2007;22(6):404-414.

Adams I and Kraushaar H. Expanded Community Based Distribution Project: Impact Analysis Report, Zimbabwe. Arlington: Advance Africa; 2005.

Uganda Bureau of Statistics, ICF International Inc. Uganda Demographic and Health Survey 2011. Kampala, Uganda: UBOS and Calverton, MD: ICF International Inc.2012.

MOH, ICF International. Uganda AIDS Indicator Survey 2011. Kampala, Uganda and Calverton Maryland, USA: Ministry of Health and ICF International; 2012.

Staveteig S, Wang S, Head SK, Bradley SEK and Nybro E. Demographic Patterns of HIV Testing Uptake in Sub-Saharan Africa. Calverton, MD: ICF International; 2013 April 2013.

WHO, USAID and FHI. Strategic Considerations for Strengthening the Linkages between Family Planning and HIV/AIDS Policies, Programs, and Services Geneva, Switzerland: World Health Organization; 2009.

Brunie A, Wamala-Mucheri P, Akol A, Mercer S and M Chen. Expanding HIV testing and counselling into communities: Feasibility, acceptability, and effects of an integrated family planning/HTC service delivery moel by Village Health Teams in Uganda. Health Policy and Planning 2016;31(8).

Brunie A, Wamala-Mucheri P, Otterness C, Akol A, Chen M, Bufumbo L and Weaver M. Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs. Global Health: Science and Practice 2014;2(1).

Alam K, Tasneem S and Oliveras E. Performance of female volunteer community health workers in Dhaka urban slums. Soc Sci Med 2012;75:511-515.

Bhattacharyya K, Winch P, LeBan K and Tien M. Community Health Worker Incentives and Disincentives: How they affect motivation, retention and sustainability. Arlington, VA: BASICS/USAID; 2001. 52 p.

Gopalan SS, Mohanty S and Das A. Assessing community health workers‘ performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme. BMJ open 2012;2(5).

Liambila W, Askew I, Mwangi J, Ayisi R and Kibaru J.

Feasibility and effectiveness of integrating provider-initiated testing and counselling within family planning services in Kenya. Aids 2009;23(Suppl 1):S115-S121.

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