title: Integrating family planning services into HIV care and treatment clinics in Tanzania: evaluation of a facilitated referral model.
abstract: BACKGROUND
  Many clients of HIV care and treatment services have unmet contraceptive needs. Integrating family planning (FP) services into HIV services is an increasingly utilized strategy for meeting those unmet needs. However, numerous models for services integration are potentially applicable for clients with diverse health needs. This study developed and tested a 'facilitated referral' model for integrating FP into HIV care and treatment in Tanzania with the primary outcome being a reduction in unmet need for contraception among female clients.
  
  
  METHODS
  The facilitated referral model included seven distinct steps for service providers. A quasi-experimental, pre- and post-test, repeated cross-sectional study was conducted to evaluate the impact of the model. Female clients at 12 HIV care and treatment clinics (CTCs) were interviewed pre- and post-intervention and CTC providers were interviewed post-intervention.
  
  
  RESULTS
  A total of 323 CTC clients were interviewed pre-intervention and 299 were interviewed post-intervention. Among all clients, the adjusted decrease in proportion with unmet need (3%) was not significant (P = 0.103) but among only sexually active clients, the adjusted decrease (8%) approached significance (P = 0.052). Furthermore, the proportion of sexually active clients using a contraceptive method post-intervention increased by an estimated 12% (P = 0.013). Dual method use increased by 16% (P = 0.004). Increases were observed for all seven steps of the model from pre- to post-intervention. All providers (n = 45) stated that FP integration was a good addition although there were implementation challenges.
  
  
  CONCLUSIONS
  This study demonstrated that the facilitated referral model is a feasible strategy for integrating FP into HIV care and treatment services. The findings show that this model resulted in increased contraceptive use among HIV-positive female clients. By highlighting the distinct steps necessary for facilitated referrals, this study can help inform both programmes and future research efforts in services integration.
authors.affiliation: FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania jbaumgartner@fhi360.org.
authors.forename: Joy Noel
authors.initials: JN
authors.lastname: Baumgartner
authors.affiliation: FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania.
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Green
authors.affiliation: FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania.
authors.forename: Gottlieb
authors.initials: G
authors.lastname: Mpangile
authors.affiliation: FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania.
authors.forename: Thecla W
authors.initials: TW
authors.lastname: Kohi
authors.affiliation: FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania.
authors.forename: Stella N
authors.initials: SN
authors.lastname: Mujaya
authors.affiliation: FHI 360, Washington, DC 20009, USA, FHI 360, Research Triangle Park, NC, USA, University of North Carolina at Chapel Hill,, Chapel Hill, NC, USA, TUNAJALI II, Deloitte, Dar es Salaam, Tanzania, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Futures Group, Dar es Salaam, Tanzania.
authors.forename: Christine
authors.initials: C
authors.lastname: Lasway
mesh_terms: D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D012017:Referral and Consultation / Q000639:trends; D013636:Tanzania; D055815:Young Adult
keywords: HIV; Tanzania; family planning; referrals; service integration
references.citation: J Acquir Immune Defic Syndr. 2011 Sep 1;58(1):115-9
references.pmid: 21546845
references.citation: Health Policy Plan. 2010 Mar;25(2):104-11
references.pmid: 19917651
references.citation: AIDS. 2009 Nov;23 Suppl 1:S79-88
references.pmid: 20081392
references.citation: Health Policy Plan. 2010 Jan;25(1):1-14
references.pmid: 19959485
references.citation: AIDS. 2004 Aug 20;18(12):1661-71
references.pmid: 15280777
references.citation: Stud Fam Plann. 2010 Jun;41(2):125-8
references.pmid: 21466112
references.citation: J Int AIDS Soc. 2010 Jul 19;13:26
references.pmid: 20642843
references.citation: Stud Fam Plann. 2000 Jun;31(2):151-62
references.pmid: 10907280
references.citation: AIDS. 2009 Nov;23 Suppl 1:S97-S103
references.pmid: 20081394
references.citation: Stud Fam Plann. 2011 Dec;42(4):283-90
references.pmid: 22292247
references.citation: Am J Obstet Gynecol. 2003 Aug;189(2):473-81
references.pmid: 14520221
references.citation: Sex Transm Infect. 2006 Jun;82(3):202-6
references.pmid: 16731668
references.citation: Bull World Health Organ. 2009 Nov;87(11):846-51
references.pmid: 20072770
references.citation: Health Policy Plan. 2010 Nov;25 Suppl 1:i4-20
references.pmid: 20966108
references.citation: Reprod Health. 2011 Oct 06;8:27
references.pmid: 21975089
references.citation: BMJ. 2011 Feb 03;342:d346
references.pmid: 21292711
references.citation: Sex Transm Dis. 2006 Jun;33(6):350-6
references.pmid: 16505747
references.citation: Infect Dis Obstet Gynecol. 2011;2011:261453
references.pmid: 22007138
references.citation: Health Policy Plan. 2005 Jul;20(4):199-212
references.pmid: 15965032
references.citation: Sex Transm Infect. 2012 Mar;88(2):85-99
references.pmid: 22158934
references.citation: Stud Fam Plann. 2009 Sep;40(3):171-86
references.pmid: 19852408
references.citation: Soc Sci Med. 1983;17(24):1971-81
references.pmid: 6670002
references.citation: AIDS. 2009 Nov;23 Suppl 1:S123-30
references.pmid: 20081384
references.citation: Reprod Health Matters. 2003 May;11(21):37-48
references.pmid: 12800702
references.citation: Int Perspect Sex Reprod Health. 2010 Dec;36(4):189-96
references.pmid: 21245025
references.citation: Health Policy Plan. 2004 Oct;19 Suppl 1:i62-i70
references.pmid: 15452016
references.citation: PLoS One. 2012;7(4):e36039
references.pmid: 22558319
references.citation: J Int AIDS Soc. 2011 Jun 30;14:35
references.pmid: 21718524
references.citation: AIDS Patient Care STDS. 2007 Apr;21(4):278-85
references.pmid: 17461723
references.citation: BMC Health Serv Res. 2012 Feb 27;12:48
references.pmid: 22369041