title: Integration of HIV and maternal healthcare in a high HIV-prevalence setting: analysis of client flow data over time in Swaziland.
abstract: OBJECTIVE
  Maternal and child health (MCH) care may provide an entry point for HIV services in high HIV-prevalence settings. Our objective was to assess integration of HIV with MCH services in public sector facilities in Swaziland.
  
  
  METHODS
  In 2009, 2010 and 2012, client flow assessments (CFAs) were conducted over 5 days in the MCH units of eight government facilities, purposively selected as intervention or comparison sites.
  
  
  METHODS
  8263 MCH visits with female clients were tracked: 3261 in 2009, 2086 in 2010 and 2916 in 2012.
  
  
  METHODS
  Activities and resources to strengthen integration of HIV services into postnatal care (PNC), 2009-2010.
  
  
  METHODS
  The proportion of all visits in which an HIV/sexually transmitted infection (STI) testing, counselling or treatment was received together with an MCH service; the proportion of all visits in which a client receives HIV counselling.
  
  
  RESULTS
  Across facilities, the proportion of visits in which HIV/STI and MCH services were received varied considerably, for example, from 9% to 49% in 2009. HIV/STI services were integrated most frequently with child health (CH), antenatal care (ANC) and family planning (FP)-the most common reasons for women's attendance-and least often with PNC and cervical screening (CS). There was no meaningful difference in integration over time by design group and considerable heterogeneity across facilities. Receipt of integrated services increased in one intervention and two comparison facilities, where HIV counselling also rose, and fell in one intervention and two comparison facilities.
  
  
  CONCLUSIONS
  Provision of HIV/STI services with MCH care occurred at all facilities, yet relatively few women receive integrated services. Increases in integration were driven by increases in HIV counselling, while sharp declines in some facilities indicate that integration is difficult to sustain. Opportunities for intensifying HIV integration lie with ANC, CH and FP, while HIV-PNC integration will remain limited until more women attend PNC.
  
  
  BACKGROUND
  Current Controlled Trials NCT01694862.
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Isolde J
authors.initials: IJ
authors.lastname: Birdthistle
authors.forename: Susannah H
authors.initials: SH
authors.lastname: Mayhew
authors.forename: Joshua
authors.initials: J
authors.lastname: Kikuvi
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhou
authors.forename: Kathryn
authors.initials: K
authors.lastname: Church
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Warren
authors.forename: Rejoice
authors.initials: R
authors.lastname: Nkambule
authors.forename: Justin
authors.initials: J
authors.lastname: Fenty
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D002648:Child; D003376:Counseling; D019033:Delivery of Health Care, Integrated / Q000379:methods; D013541:Eswatini; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D000068101:Maternal-Child Health Services; D011181:Postnatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011295:Prenatal Care; D015995:Prevalence; D015397:Program Evaluation; D017150:Public Sector; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult
keywords: REPRODUCTIVE MEDICINE; SEXUAL MEDICINE