title: Service delivery characteristics associated with contraceptive use among youth clients in integrated voluntary counseling and HIV testing clinics in Kenya.
abstract: Youth attending voluntary counseling and HIV testing (VCT) services often have unmet need for contraception. Integrated family planning (FP) and HIV services can address dual HIV and unintended pregnancy prevention needs. However, little is known about which VCT service characteristics, such as quality of care, strength of FP-HIV service integration, and youth-friendliness, affect contraceptive behavior. This study explores the facility- and provider-level characteristics that may be associated with same day uptake or intention to use contraception after a VCT visit, and contraceptive use three months later among youth clients, controlling for client characteristics. This was a descriptive study conducted in 20 integrated VCT clinics across Kenya. Data collection included 20 structured clinic observations, 349 baseline interviews with male and female clients aged 15-24 after their VCT visit plus 277 follow-up interviews with clients three months later, and interviews with 46 providers who served the clients at the study clinics. Client, provider, and structured observation data were linked and multi-level logistic path models were used for analyses. Results revealed little evidence of specific service characteristics being associated with contraceptive behavior. However, VCT providers were not routinely screening for risk of unintended pregnancy or counseling on contraception. Results are likely a reflection of suboptimal integrated services. The clinics were serving youth with unmet contraceptive need and therefore integrated services should be strengthened overall to ensure no missed opportunities.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. jb3219@columbia.edu
authors.forename: Joy Noel
authors.initials: JN
authors.lastname: Baumgartner
authors.forename: Rose
authors.initials: R
authors.lastname: Otieno-Masaba
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Grey
authors.forename: Heidi W
authors.initials: HW
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D003267:Contraception; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003376:Counseling / Q000458:organization & administration; D003695:Delivery of Health Care / Q000592:standards*; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D012725:Sexual Behavior / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D035141:Voluntary Programs / Q000458:organization & administration*; D055815:Young Adult