title: Improving referrals and integrating family planning and HIV services through organizational network strengthening.
abstract: BACKGROUND
  The service needs of people with human immunodeficiency virus (HIV) in low-income settings are wide-ranging. Service provision in a community is often disjointed among a variety of providers. We sought to reduce unmet patient needs by increasing referral coordination for HIV and family planning, measured as network density, with an organizational network approach.
  
  
  METHODS
  We conducted organizational network analysis on two networks in sub-cities of Addis Ababa, Ethiopia. There were 25 organizations in one sub-city network and 26 in the other. In one of them we sought to increase referrals through three network strengthening meetings. We then conducted the network analysis again in both sub-cities to measure any changes since baseline. We also quantitatively measured reported client service needs in both sub-cities before and after the intervention with two cross-sectional samples of face-to-face interviews with clients (459 at baseline and 587 at follow-up).
  
  
  RESULTS
  In the sub-city with the intervention, the number of referral connections between organizations, measured as network density, increased 55%. In the control community, the density decreased over the same period. Reported unmet client service needs declined more consistently across services in the intervention community.
  
  
  CONCLUSIONS
  This quasi experiment demonstrated that (1) an organizational network analysis can inform an intervention, (2) a modest network strengthening intervention can enhance client referrals in the network, (3) improvement in client referrals was accompanied by a decrease in atient-reported unmet needs and (4) a series of network analyses can be a useful evaluation tool.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA jim.thomas@unc.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Thomas
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Heidi W
authors.initials: HW
authors.lastname: Reynolds
authors.affiliation: Management Sciences for Health, Washington, DC, USA.
authors.forename: Xavier
authors.initials: X
authors.lastname: Alterescu
authors.affiliation: North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA and.
authors.forename: Christine
authors.initials: C
authors.lastname: Bevc
authors.affiliation: Medici con l'Africa Cuamm, Addis Ababa, Ethiopia.
authors.forename: Ademe
authors.initials: A
authors.lastname: Tsegaye
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005002:Ethiopia; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012017:Referral and Consultation / Q000592:standards*; D055815:Young Adult
keywords: Family planning; HIV/AIDS; global health; integration; network analysis; quasi-experiment