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.
Methods and Findings
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.
Below: Description of Data Sources used in Integra Indexes
Full article at: http://goo.gl/hZqNGj
By:
Susannah H. Mayhew, Sedona Sweeney, Charlotte Watts, Anna
Vassall
Department of Global Health & Development, London School
of Hygiene & Tropical Medicine (http://www.lshtm.ac.uk/), 15–17 Tavistock Place, London, WC1H 9SH,
United Kingdom
George B. Ploubidis
Centre for Longitudinal Studies, Department of Social
Science, UCL Institute of Education, University College London, 55–59 Gordon
Square, London, WC1H 0NU, United Kingdom
Andy Sloggett, Kathryn Church, Isolde Birdthistle
Department of Population Health, London School of Hygiene
& Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
Carol D. Obure
Department of Epidemiology and Public Health, Swiss Tropical
and Public Health Institute, P.O. Box 4002, Basel, Switzerland
Charlotte E. Warren
Reproductive Health Services and Research, Population
Council, Suite 280, 4301 Connecticut Ave NW, Washington, District of Columbia,
20008, United States of America
More at: https://twitter.com/hiv insight
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