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Integrating counseling and testing for HIV into FP services in Kenya is feasible, acceptable and effective in increasing VCT uptake and improving the quality of care
Presented by Robert Ayisi, Kenya.
R. Ayisi1, W. Liambila2
1NASCOP, HIV/AIDS, Nairobi, Kenya, 2Population Council, Nairobi, Kenya
Background: In Kenya data on integrating CT into family planning is scarce and far between. From May 2006 to March 2007, we compared feasibility of two models for integrating VCT into existing family planning.In the “testing” model, providers offered VCT and post-test counseling during the same visit, while in the “referral” model, clients requesting VCT were referred to a specialized VCT facility. Interventions were piloted in 23 rural and urban facilities in two administrative districts (Nyeri) with limited VCT services, another (Thika) offering VCT at a number of sites. A total of 75 providers in both areas received training on integrating counseling and testing into family planning.
Focus group discussions, facility assessments, as well as observation of client-provider interactions and client exit interviews were used to determine HIV testing rates as well as feasibility and cost.
Methods: A total of 552 clients were interviewed at baseline and 530 at the end. Integrating VCT with family planning was feasible and acceptable to clients and providers. Among repeat FP clients, there was a significant increase in the proportion of clients reporting that they had ever had an HIV test in the testing (46% to 81%) compared to (41% to 59%) in the referral group.
Cost of integrating CT into FP averaged $US2.50 per family planning client tested. Cost of integration was lowest in dispensaries ($548), followed by health centers ($1,156), and highest in hospitals $2,411. This suggests that investing in integration at lower-level facilities could be a cost-effective approach for increasing access to integration.
Conclusion: Based on findings from the pilot intervention, Ministry of Health recommended expanding integration to other districts nationally. Despite constraints such as staff shortage, integration of counseling and testing into FP services was found to be feasible and increased clients access to STI and HIV testing without compromising the quality of existing services.
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