title: Integrating reproductive health services into HIV care: strategies for successful implementation in a low-resource HIV clinic in Lilongwe, Malawi.
abstract: BACKGROUND
  Lighthouse Trust operates two public HIV testing, treatment and care clinics in Lilongwe, Malawi, caring for over 26 000 people living with HIV, 23 000 of whom are on antiretroviral treatment (ART). In August 2010, Lighthouse Trust piloted a step-wise integration of sexual and reproductive health (SRH) services into routine HIV care at its Lighthouse clinic site. The objectives were to increase uptake of family planning (FP), promote long-term reversible contraceptive methods, and increase access, screening and treatment for cervical cancer using visual inspection with acetic acid.
  
  
  RESULTS
  Patients found integrated SRH/ART services acceptable; service availability appeared to increase uptake. Between August 2010 and May 2014, over 6000 women at Lighthouse received FP education messages. Of 859 women who initiated FP, 55% chose depot medroxyprogesterone acetate, 19% chose an intrauterine contraceptive device, 14% chose oral contraceptive pills, and 12% chose an implant. By May 2014, 21% of eligible female patients received cervical cancer screening: 11% (166 women) had abnormal cervical findings during screening for cervical cancer and underwent further treatment.
  
  
  CONCLUSIONS
  Several lessons were learned in overcoming initial concerns about integration. First, our integrated services required minimal additional resources over those needed for provision of HIV care alone. Second, patient flow improved during implementation, reducing a barrier for clients seeking multiple services. Lastly, analysis of routine data showed that the proportion of women using some form of modern contraception was 45% higher at Lighthouse than at Lighthouse's sister clinic where services were not integrated (42% vs 29%), providing further evidence for promotion of SRH/ART integration.
authors.affiliation: Executive Director, The Lighthouse Trust, Lilongwe, Malawi and Professor, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.affiliation: Monitoring, Evaluation and Research Technical Advisor, The Lighthouse Trust, Lilongwe, Malawi and International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA.
authors.forename: Caryl
authors.initials: C
authors.lastname: Feldacker
authors.affiliation: Clinic Coordinator, The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chaweza
authors.affiliation: Clinic Nurse, The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Linly
authors.initials: L
authors.lastname: Mlundira
authors.affiliation: Monitoring Evaluation and Research Manager, The Lighthouse Trust, Lilongwe, Malawi and International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.affiliation: Clinical Technical Advisor, The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Colin
authors.initials: C
authors.lastname: Speight
authors.affiliation: Data Clerk, The Lighthouse Trust, Lilongwe, Malawi.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Samala
authors.affiliation: Director, Reproductive Health Unit, Ministry of Health, Lilongwe, Malawi.
authors.forename: Fannie
authors.initials: F
authors.lastname: Kachale
authors.affiliation: MD Candidate, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Umpierrez
authors.affiliation: Assistant Professor, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Haddad
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D003267:Contraception / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D008295:Malawi; D008875:Middle Aged; D009936:Organizational Innovation; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D055815:Young Adult
keywords: cervical screening; education and training; family planning service provision; human immunodeficiency virus; long-acting reversible contraception; service delivery