Feasibility, acceptability, effect and cost of integrating counseling and testing for HIV within family planning services in Kenya

Systematic evidence about offering CT in FP settings has remained extremely limited, despite the widespread interest in this model of FP-HIV integration. FRONTIERS supported the Division of Reproductive Health (DRH) and the National AIDS and STI Control Program (NASCOP) of the Kenya Ministry of Health (MOH) to design, implement and compare two models of integrating CT for HIV within FP services in 23 health facilities in Nyeri and Thika Districts of Central Province, Kenya in terms of their feasibility, acceptability, cost and effect on the voluntary use of CT, as well as the quality of FP services. The study utilized a pre-post intervention design to obtain information from FP providers and their clients in 2006 to 2007.Data were collected through provider-client observations (554 at baseline and 530 at endline) and client exit interviews (552 at baseline and 530 at end line), pre and post intervention interviews and focus group discussions with health providers, and a health facility assessment of the readiness of facilities to offer HIV CT within FP services. Introduction and implementation involved: (a) holding sensitization meetings at national, provincial and district levels; (b) reviewing and developing training materials; (c) application of the Balanced Counseling Strategy (BCS) Plus approach; (d) modification of facility registers to record the required data; and (e) training of health providers. The MOH provided all required equipment and supplies, including HIV rapid test kits and FP commodities. Two models were pilot-tested. The "testing" model was implemented in Nyeri District, an area with relatively few VCT sites. In this model, FP clients were educated about HIV prevention generally, and CT in particular, and offered HIV CT during this consultation by the FP provider. The "referral" model was implemented in Thika district, an area with good accessibility to VCT services. In this model, FP clients were educated about HIV CT, and those interested were instead referred to a specialized CT service, either within the same facility or to another CT service (at another health facility or a stand-alone VCT center). The study demonstrated that both models were feasible and acceptable to providers and to clients as means of integrating and linking HIV prevention counseling, condom promotion and counseling and testing with FP services, and are effective in increasing quality of care and service utilization. (Author abstract, modified)