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

From: Study protocol for the Integra Initiative to assess the benefits and costs of integrating sexual and reproductive health and HIV services in Kenya and Swaziland

Objective 1. Determine the benefits of different integrated models to increase range, uptake and quality of selected SRH and HIV services and to diversify the profile of clients.
Results/Outcomes Indicators Data source
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