Randomized evaluation and cost-effectiveness of HIV and sexual and reproductive health service referral and linkage models in Zambia

BMC Public Health

Research Article

Fiammetta Bozzani¹  Mary Nambao²  Lung Vu³  Eileen Yam³  Paul C. Hewett³  Jean Digitale⁴  Mutinta Nalubamba⁵ 

[1] London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK;Ministry of Health, Zambia, Ndeke House, Lusaka, Zambia;Population Council, 4301 Connecticut Avenue, 20008, Washington, DC, USA;Population Council, One Dag Hammarskjold Plaza, 10017, New York, NY, USA;Society for Family Health, Plot 549 Ridgeway, 10101, Lusaka, Zambia;

关键词: Randomized evaluation;    Integration;    HIV services;    Sexual and reproductive health services;    Family planning;    Voluntary medical male circumcision;    HIV testing and counseling;    Cervical cancer screening;   

DOI  :  10.1186/s12889-016-3450-x

 received in 2015-12-15, accepted in 2016-08-05,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundProvision of HIV prevention and sexual and reproductive health services in Zambia is largely characterized by discrete service provision with weak client referral and linkage. The literature reveals gaps in the continuity of care for HIV and sexual and reproductive health. This study assessed whether improved service delivery models increased the uptake and cost-effectiveness of HIV and sexual and reproductive health services.MethodsAdult clients 18+ years of age accessing family planning (females), HIV testing and counseling (females and males), and male circumcision services (males) were recruited, enrolled and individually randomized to one of three study arms: 1) the standard model of service provision at the entry point (N = 1319); 2) an enhanced counseling and referral to add-on service with follow-up (N = 1323); and 3) the components of study arm two, with the additional offer of an escort (N = 1321). Interviews were conducted with the same clients at baseline, six weeks and six months. Uptake of services for HIV, family planning, male circumcision, and cervical cancer screening at six weeks and six months were the primary endpoints. Pairwise chi-square and multivariable logistic regression statistical tests assessed differences across study arms, which were also assessed for incremental cost-efficiency and cost-effectiveness.ResultsA total of 3963 clients, 1920 males and 2043 females, were enrolled; 82 % of participants at six weeks were tracked and 81 % at six months; follow-up rates did not vary significantly by study arm. The odds of clients accessing HIV testing and counseling, cervical cancer screening services among females, and circumcision services among males varied significantly by study arm at six weeks and six months; less consistent findings were observed for HIV care and treatment. Client uptake of family planning services did not vary significantly by study arm. Integrated services were found to be more efficiently provided than vertical service provision; the cost-effectiveness for HIV/AIDS and cervical cancer was high in the enhanced service models.ConclusionsStudy results provide evidence for increasing the linkages and integration of a selection of HIV and sexual and reproductive health services. The study provided cost-effective service delivery models that enhanced the likelihood of clients accessing some additional needed health services.Trial registrationISRCTN84228514 Retrospectively registered.The study was retrospectively registered in the ISRCTN clinical trials registry on 06 October 2015. The first recruitment of participants occurred on 17 December 2013.

【 授权许可】

CC BY   
© The Author(s). 2016