Table 3 Operational results and indicators to be used to compare results from the intervention and comparison health facilities

Feasibility of linking services demonstrated

Number of internal and external referrals, Number of staff updated in HIV counseling and testing Number of staff updated in HIV BCC prevention, Facilities have adequate equipment and supplies

Service statistics Provider interviews Facility inventory

Provision of linked services to clients

Clients received CT in FP consultation, Clients referred for ART, Clients referred for other services, Number of referrals attended, Proportion of population demanding integrated services, Proportion of population accessing integrated services, Proportion of services users giving integration as a reason for choice of clinic

Client exit Provider interview Cohort Community Survey

Increased % of eligible HIV+ women starting to use ART

Proportion of women reaching referral site clients know their CD4 counts

Service statistics Cohort

Increased uptake of range of SRH services including integrated CT, FP, PNC and STI screening services

% FP clients accessing more than one service Proportion of population accessing more than one service at last FP or PNC visit

Service statistics Exit /Cohort Community Survey

Increased quality of a range of SRH services

% clients receiving minimum level of quality services

Client – provider interaction, exit interview

Increase in number and diversity of clients

% men and women using component services Proportion of clients using component services by age, SES and gender

Community Service Statistics Client exit /CPI

Increased numbers of clients screened/managed for STIs

% FP clients accessing separate/integrated services

Service statistics Client Flow Cohort

Increased in new and repeat FP clients testing for HIV

Service statistics Cohort

Improved attitudes of service providers towards HIV+ clients

% Providers indicating non discriminatory attitudes % Clients recommending services to others

Provider interview Cohort survey Community Survey

Objective 2. Determine the impact of different integrated services on changes in HIV risk-behavior; HIV related stigma and unintended pregnancies.

Reduction in reported HIV risk behaviors among HIV negative & HIV positive clients

Condom use at last sex; Number of partners in past 12 months Received STI/HIV counseling Consistent condom use reported Use of condoms with another FP method (dual protection)

Cohort Client Exit Community Survey

Reduced incidence of unintended pregnancies

% women who become pregnant (incidence) % women reporting planned pregnancy % women with correct knowledge of fertile period % of population who report unintended pregnancy in last 12 months

Cohort Client Exit Community Survey

Increased duration of contraceptive use among HIV negative & HIV positive clients

Ever/current use of FP method Discontinuation FP rates in 12 months Ability to achieve fertility goals

Cohort survey

Improved attitudes of service providers towards HIV+ clients

Proportion of providers indicating non discriminatory attitudes towards HIV positive clients

Provider interview

Reduced stigma at health facilities.

Clients reporting positive experience of CT process % clients reporting unacceptable stigmatizing behavior by providers

Community and Cohort survey

Decreased stigmatization at community level of HIV services if integrated with FP RH services

Perceived barriers to accessing services: costs, distance, quality, waiting times, stigma surrounding service

Community survey Cohort survey

Objective 3: Establish the efficiency of using different operational models for delivering integrated services in terms of: cost, utilization of existing infrastructure and human resources.

Total resource requirements and unit costs of intervention

Cost per eligible client receiving ART, Cost per person-month of receiving ART Cost per client counseled, tested and receiving results Cost per client receiving each service component

Economic study