title: The use of routine monitoring and evaluation systems to assess a referral model of family planning and HIV service integration in Nigeria.
abstract: OBJECTIVE
  To measure changes in service utilization of a model integrating family planning with HIV counselling and testing (HCT), antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in the Nigerian public health facilities.
  
  
  METHODS
  It is a retrospective survey of attendance and family planning commodity uptake in 71 health facilities in Nigeria that analyzes the preintegration and postintegration periods between March 2007 and January 2009.
  
  
  METHODS
  A prepost retrospective comparison of mean attendance at family planning clinics and couple-years of protection (CYP) compared 6 months preintegration with 9 months postintegration period. An analysis of service ratios was conducted, relating completed referrals at family planning clinics to service utilization at the referring HIV clinics.
  
  
  RESULTS
  Mean attendance at family planning clinics increased significantly from 67.6 in preintegration to 87.0 in postintegration. The mean CYP increased significantly from 32.3 preintegration to 38.2 postintegration. Service ratio of referrals from each of the HIV clinics was low but increased in the postintegration period by 4, 34 and 42 per 1000 clients from HCT, ART and PMTCT clinics, respectively. Service ratios were higher in primary healthcare settings than in secondary or tertiary hospitals. Attendance by men at family planning clinics was significantly higher among clients referred from HIV clinics.
  
  
  CONCLUSIONS
  Family planning-HIV integration using the referral model improved family planning service utilization by clients accessing HIV services, but further improvement is possible. Male utilization of family planning services also improved. The government of Nigeria should review the family planning user fee policy and scale up the integration in primary healthcare facilities.
authors.affiliation: Family Health International, Global HIV/AIDS Initiative Nigeria, Abuja, Nigeria.
authors.forename: Nzapfurundi O
authors.initials: NO
authors.lastname: Chabikuli
authors.forename: Dorka D
authors.initials: DD
authors.lastname: Awi
authors.forename: Ogo
authors.initials: O
authors.lastname: Chukwujekwu
authors.forename: Zubaida
authors.initials: Z
authors.lastname: Abubakar
authors.forename: Usman
authors.initials: U
authors.lastname: Gwarzo
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Mike
authors.initials: M
authors.lastname: Merrigan
authors.forename: Christoph
authors.initials: C
authors.lastname: Hamelmann
mesh_terms: D000328:Adult; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D005193:Family Planning Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D015397:Program Evaluation; D012017:Referral and Consultation; D012189:Retrospective Studies; D012737:Sex Factors