Table 1.
Summary of the interventions in FP and PNC sites
| Intervention component | Model 1: FP-HIV Kenya | Model 2: PNC-HIV | |
|---|---|---|---|
| Pre-existing standard services |
·Counselling & provision of FP methods |
·Timing: Usually delivered on discharge if hospital delivery, with 6 week check: |
|
| |
·Dual protection counselling |
·Content: |
|
| |
·Screening of STIs |
·Immunisation |
|
| |
·HIV prevention counselling |
·Growth monitoring/child welfare |
|
| |
·Counselling on sex & sexuality, childbearing and PMTCT. |
·FP at six weeks postpartum (on request from mother) |
|
| |
·Refer FP clients for STI treatment/ syndromic management |
(NB: this is what should happen according to the guidelines but rarely does at facility level) |
|
| |
·Refer FP clients for HIV counseling and testing |
|
|
| |
(NB: this is what should happen according to the guidelines but rarely does at facility level) |
|
|
| Strengthened or additional services introduced |
·All clients receive strengthened Standard FP services using the Balanced Counseling Strategy Plus. This includes: |
·Timing: within 48 hours of delivery, plus 7 day, and 6 week visit at facility |
|
| |
·Discussion of fertility desires, |
·Content: |
|
| |
·Offering a range of FP methods |
·Mother and baby physical examination to detect danger signs, complications, anomalies |
|
| |
·Ensuring suitability of FP methods |
·Infant feeding counseling |
|
| |
·Condom promotion/provision |
·Postpartum FP counseling and provision |
|
| |
·STI and HIV risk assessment |
·Screening for cervical cancer (at 6 weeks) |
|
| |
·Check client HIV status |
·HIV counselling & testing (mother and baby) |
|
| |
·HIV counseling and testing |
·HIV treatment prophylaxis for |
|
| |
·Screening for cancer of cervix (via /vili) |
·mother and baby |
|
| |
STI screening and management Arrange follow up appointments |
Neonatal male circumcision (Swaziland only) |
|
| |
HIV negative clients Health promotion Risk factor exposure Risk assessment (routine) for STI/HIV |
||
| |
HIV positive clients Counseling on HIV care and treatment available Manages clients with CD4 count >350 CTX prophylaxis Referred to lab/ART unit for blood tests |
||
| Adaptation/ strengthening of protocols, guidelines and training materials |
·Development, adaptation or updating of guidelines and protocols (where necessary) based on national guidelines and manuals |
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| |
·Mentoring toolkit developed - includes trainers guide, log book for mentees, checklist |
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| |
·Balanced Counseling Strategy Plus second edition adapted to include cervical cancer screening and postpartum car |
||
| Staff training & management |
·Development of an appropriate training and monitoring/ supervisory package which was grounded on the mentorship methodology and used the Balanced Counselling Strategy Plus (BCS+) toolkit |
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| |
·Facilitative supervision comprising initially of bi-monthly and later quarterly visits by supervisory teams from the Ministries of Health and Population Council |
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| |
·Training on technical skills for provision of long acting FP methods (IUDs and implants) |
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| |
·Training on HIV counseling and testing, conseling on HIV services available, ARV refills, screening for STIs and syndromic management of STIs |
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| Organizational change and role clarification |
·Organizational change of how services are provided (rooms identified for integrated services, partitions built to create more rooms and staff reallocated |
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| |
·Role clarification with all staff - task oriented work changed to provision of services according to client need |
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| Equipment & supplies |
·Ensuring availability of minimum levels of equipment and supplies (e.g., implant/IUD insertion kits, blood pressure machines and stethoscopes) required for providing integrated services |
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| Communication aids |
·Improving the availability of information, education and communication/behavioral counseling and communication (IEC/BCC) materials. All IEC materials pertaining to FP/HIV and PNC/HIV reviewed and adapted to reflect provision of integrated services |
||
| Referral systems |
·Strengthened referral system between SRH clinics and ART centres (introduction of new referral forms (Kenya only) |
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| Data collection and management | ·Strengthening data collection and recording systems through the development of data capture tools, (e.g., PNC registers and monthly data monitoring forms) | ||