Barcelona 2013
Barcelona 2013
Abstract book - Abstract - 547
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Conference Details
International Committee
Plenary Speakers
Presenting Speakers
Scientific Committee
Abstract #547  -  Testing
  4.2: Testing (Parallel) on Monday @ 11.00-13.00 in Teatre Chaired by Lorna Leal,
Frans van den Boom

  Presenting Author:   Dr Susannah Mayhew - London School of Hygiene & Tropical Medicine, United Kingdom
  Additional Authors:   
Despite wide ? and polarised ? debate on the benefits of health service integration there are no common definitions of ?integration? and no standard measures of its impact. Few studies have attempted to measure and rank integrated care, describe the relative importance of intervention components or describe the relationship between integrated services and a particular service or health outcome. The Integra Initiative is a complex evaluation of different models of integrating HIV testing and treatment into other reproductive health services. We developed an ?Index? to measure the precise degree of integration at facility level, describing the relative efficiency and effectiveness of integrated service provision, in order to robustly assess the health and service impact of integration.
Method / Issue:
We employed a Bayesian approach, incorporating expert knowledge in the derivation of the index. We used multidimensional latent variable measurement models, suitable for the nature of the data and derived latent dimensions of integration. All models were estimated with the Mplus 6.12 software. Data were drawn from client flow and economic costing tools implemented between 2009-2011 in 40 clinics in Kenya and Swaziland. The resulting Index was applied to measure the impact of integrated delivery of care on HIV prevention outcomes among a cohort of 1086 women attending FP services at 12 clinics in Central Province, Kenya who were followed for 24months.
Results / Comments:
The Index measures four dimensions of HIV-Reproductive health service integration derived from the data: physical integration (service location/layout of a building or clinic); temporal integration (proportion of integrated services available per day); provider integration (proportion of integrated services provided per provider) and functional integration (proportion of clients who received integrated services in one visit). The attributes of each dimension were validated by a group of experts including service providers and researchers and weighted accordingly. Application of the Index to measure impact of integrated service delivery and HIV prevention outcomes showed that at 24 months follow up 40% women in a cohort of FP clients attending highly integrated services (as measured by the Index) received integrated HIV counselling and testing services compared to less than 20% women attending low-integrated facilities. 94% Women in highly integrated facilities had 2-3 tests in the previous 24 months compared to 60% in low-integrated clinics and 92% had their last test in the previous 12 months compared to 74% in low-integrated facilities. Overall unmet need for HIV prevention was 7% in women attending highly integrated facilities compared to 25% attending low-integrated facilities ? a significant difference.
The derived Index is an important methodological contribution to enabling the attribution of particular health/service outcomes to integration ? an achievement which has proven elusive to date. Our application showed that integrated delivery of HIV testing within FP services can improve HIV testing rates and reduce unmet need for HIV prevention among FP clients.
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