title: Integrating HIV prevention in reproductive health settings.
abstract: BACKGROUND
  This article describes results of a process evaluation of a cooperative agreement between the Centers for Disease Control and Prevention's Division of Reproductive Health and 10 regional training centers to increase the number of reproductive health (RH) settings that integrate human immunodeficiency virus (HIV) prevention services at an appropriate level into routine care.
  
  
  OBJECTIVE
  Our goal was to learn about the process of integrating HIV prevention into RH settings.
  
  
  METHODS
  We conducted a retrospective evaluation, using qualitative methods.
  
  
  METHODS
  The clinics were from 10 US Department of Health and Human Services regions.
  
  
  METHODS
  We interviewed 16 key informants from 10 selected model clinics.
  
  
  METHODS
  The main outcome was organization change.
  
  
  RESULTS
  The most common obstacles to integration were staff issues, logistics barriers, inadequate clinic structure to support integration, and staff training barriers. Using the transtheoretical model (TTM) applied to organizations, we documented organizational change as informants described their clinics' progression to integration and overcoming obstacles. All model clinics began in the contemplation stage of transtheoretical model. Every clinic exhibited at least 1 process of change for every stage. In the contemplation stage, most informants discussed fears about not changing, stated that the integration was consistent with the agency's mission, and described thinking about commitment to the change. In the preparation stage, all informants described building teams that supported integration of HIV prevention. During the action stage, informants talked about assessments of facilities, staff and protocols, commitments through grants or agreements, and then using training to support new behaviors and adopting new cognitions. In the maintenance stage, all reported changing policies, procedures, or protocols, most promoted helping relationships among the staff, and nearly all reported rewards for the new ways of working.
  
  
  CONCLUSIONS
  RH settings were able to integrate HIV prevention services by employing a systematic process.
authors.affiliation: Division of Reproductive Health/NCCDPHP, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS K22, Atlanta, GA 30341, USA. MZotti@cdc.gov
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Zotti
authors.forename: Johanna
authors.initials: J
authors.lastname: Pringle
authors.forename: Gary
authors.initials: G
authors.lastname: Stuart
authors.forename: William A
authors.initials: WA
authors.lastname: Boyd
authors.forename: Dabo
authors.initials: D
authors.lastname: Brantley
authors.forename: Lori
authors.initials: L
authors.lastname: de Ravello
mesh_terms: D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008962:Models, Theoretical; D011314:Preventive Health Services; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000517:prevention & control