using facilitated referrals to integrate family planning services into hiv care and treatment...
TRANSCRIPT
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Using Facilitated Referrals to Integrate Family Planning Services into HIV Care and Treatment Clinics in Tanzania
Mackenzie S. Green, Mark A. Weaver, Thecla W. Kohi, Stella N. Mujaya, Christine Lasway, Gottlieb Mpangile, Joy Noel Baumgartner
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Background
• 2006 FHI assessment found high levels of unmet need among sexually active ART clients
• 2008 MOHSW request to FHI to develop and test a facilitated referral model– Joint request from National AIDS Control Programme and
Reproductive and Child Health Section
• Facilitated referrals are enhanced referrals for additional services– Consist of specific actions to encourage completion of the
referral
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Facilitated Referral Model
1. SCREEN
2. COUNSEL
3. REFER
4. RECORD
5. ACCOMPANY
6. ACCESS
7. MONITORFP
CTC
Screen clients to learn fertility intentions and current FP use
Provide minimal counselling on FP options or on safer pregnancy
Refer clients with need to FP clinic and Record referral
Accompany clients to FP clinic
Clients with referrals access FP services
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Intervention Elements
• Service Delivery Guidelines
• Site Assessment Visit• Training
– 2 days for CTC staff– 3 day for FP staff– 1 day CTC & FP In-Charges
• Job Aids • Recording Codes• Supportive supervision
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Intervention Facilities
• 12 intervention facilities– FHI-supported care and
treatment programs– Includes hospitals and
health centers
• Selected for:– High CTC client load– Co-location of CTCs with
FP clinics
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Evaluation Study
• Quasi-experimental• Pre- and post-test• Cross-sectional
• CTC clients – Women, 18-45 years, WHO Stage I-III or CD4>100– Recruited at CTC; interviewed after all services
• CTC and FP providers, In-charges
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Results
• CTC clients interviewed:– 323 at Baseline; 299 at Post-intervention
• Characteristics similar among Baseline & Post-intervention women– 3-4% currently pregnant– 35-40% would like another child– 70% on ARVs
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FP Need Among Non-Pregnant CTC Clients at Baseline and Post-Intervention
8
12
43
33
49
55
0% 20% 40% 60% 80% 100%
Unmet Need Met Need No Need
Percent of Non-Pregnant CTC Clients
Post-Intervention
(n=291)
Baseline (n=309)
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FP Methods Used by CTC Clients Sexually Active in Last 3 Months
Baseline (n=161)
Post (n=161)
% %Modern method use (non condom) 17 39
Pill 7 17Injection 7 16Implant 2 5Female sterilization 1 2IUD 1 1
Condom use 72 85Consistent 50 61Inconsistent 22 24
CTC Clients Sexually Active in Last 3 Months
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FP Methods Used by CTC Clients Sexually Active in Last 3 Months
Baseline (n=161)
Post (n=161)
% %Dual-method use 12 31
Only modern method (non-condom) 6 8
Only condom use 60 54
No method 22 7
CTC Clients Sexually Active in Last 3 Months
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Facilitated Referral Process Reported by CTC Clients at Baseline and Post-Intervention
0 10 20 30 40 50 60 70 80 90 100
Started FP/Got appt
Completed referral
Given referral slip
Referred to FP services
Told about FP available
Asked using FP now
Asked want pregnancy 1 yr
Asked sexually active
Post-Intervention (n=299) Baseline (n=323)
Percent CTC Clients
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Future Planning
• Screen clients comprehensively• Target the right women for referrals• Take steps to minimize stigma• Ensure functioning referral system• Anticipate provider burden• Involve men
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Summary
• Increase in reported screening, FP discussions, and provision of referrals
• Positive impact on FP uptake, particularly dual method use
• Feasible option for integrating services:– Facilities with co-located CTC and FP services– Locations with limited human or other resources– Utilize existing primary health system