title: Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration.
abstract: BACKGROUND
  The body of knowledge on evaluating complex interventions for integrated healthcare lacks both common definitions of 'integrated service delivery' and standard measures of impact. Using multiple data sources in combination with statistical modelling the aim of this study is to develop a measure of HIV-reproductive health (HIV-RH) service integration that can be used to assess the degree of service integration, and the degree to which integration may have health benefits to clients, or reduce service costs.
  
  
  RESULTS
  Data were drawn from the Integra Initiative's client flow (8,263 clients in Swaziland and 25,539 in Kenya) and costing tools implemented between 2008-2012 in 40 clinics providing RH services in Kenya and Swaziland. We used latent variable measurement models to derive dimensions of HIV-RH integration using these data, which quantified the extent and type of integration between HIV and RH services in Kenya and Swaziland. The modelling produced two clear and uncorrelated dimensions of integration at facility level leading to the development of two sub-indexes: a Structural Integration Index (integrated physical and human resource infrastructure) and a Functional Integration Index (integrated delivery of services to clients). The findings highlight the importance of multi-dimensional assessments of integration, suggesting that structural integration is not sufficient to achieve the integrated delivery of care to clients--i.e. "functional integration".
  
  
  CONCLUSIONS
  These Indexes are an important methodological contribution for evaluating complex multi-service interventions. They help address the need to broaden traditional evaluations of integrated HIV-RH care through the incorporation of a functional integration measure, to avoid misleading conclusions on its 'impact' on health outcomes. This is particularly important for decision-makers seeking to promote integration in resource constrained environments.
authors.affiliation: Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
authors.forename: Susannah H
authors.initials: SH
authors.lastname: Mayhew
authors.affiliation: Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, 55-59 Gordon Square, London, WC1H 0NU, United Kingdom.
authors.forename: George B
authors.initials: GB
authors.lastname: Ploubidis
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: Sloggett
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Church
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland.
authors.forename: Carol D
authors.initials: CD
authors.lastname: Obure
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
authors.forename: Isolde
authors.initials: I
authors.lastname: Birdthistle
authors.affiliation: Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
authors.forename: Sedona
authors.initials: S
authors.lastname: Sweeney
authors.affiliation: Reproductive Health Services and Research, Population Council, Suite 280, 4301 Connecticut Ave NW, Washington, District of Columbia, 20008, United States of America.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Warren
authors.affiliation: Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
authors.affiliation: Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000379:methods*; D013541:Eswatini; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007630:Kenya; D008297:Male; D017146:Models, Organizational; D015233:Models, Statistical; D060728:Reproductive Health / Q000706:statistics & numerical data*; D034121:Reproductive Health Services / Q000706:statistics & numerical data*