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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
general
Innovation in evaluating the impact of integrated service-delivery: The integra indexes of HIV and reproductive health integration
PLoS ONE, Volume 11, No. 1, Article e0146694, Year 2016
Notification
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Description
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 multiservice 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. © 2016 Mayhew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC4723242/bin/pone.0146694.s001.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC4723242/bin/pone.0146694.s002.xls
Authors & Co-Authors
Mayhew, Susannah Harding
United Kingdom, London
London School of Hygiene & Tropical Medicine
Ploubidis, George Basil
United Kingdom, London
University College London
Sloggett, Andy
United Kingdom, London
London School of Hygiene & Tropical Medicine
Church, Kathryn
United Kingdom, London
London School of Hygiene & Tropical Medicine
Obure, Carol Dayo
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Birdthistle, Isolde J.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Sweeney, Sedona
United Kingdom, London
London School of Hygiene & Tropical Medicine
Warren, Charlotte E.
United States, New York
The Population Council, Inc.
Watts, Charlotte H.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Vassall, Anna
United Kingdom, London
London School of Hygiene & Tropical Medicine
Abuya, Timothy O.
United States, New York
The Population Council, Inc.
Askew, Ian D.
United States, New York
The Population Council, Inc.
Colombini, Manuela
United Kingdom, London
London School of Hygiene & Tropical Medicine
Friend-DuPreez, Natalie
United Kingdom, London
London School of Hygiene & Tropical Medicine
Kikuvi, Joshua
United States, New York
The Population Council, Inc.
Kimani, James Kelly
United States, New York
The Population Council, Inc.
Kivunaga, Jackline
United States, New York
The Population Council, Inc.
Mak, Joelle Y.T.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Michaels-Igbokwe, Christine
Unknown Affiliation
Mutemwa, Richard I.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Ndigwa, Charity
Unknown Affiliation
Zhou, Weiwei
Unknown Affiliation
Collumbien, Martine
United Kingdom, London
London School of Hygiene & Tropical Medicine
Howard, Natasha
United Kingdom, London
London School of Hygiene & Tropical Medicine
Obure, Dayo Carol
United Kingdom, London
London School of Hygiene & Tropical Medicine
Mdawida, Brian
United States, New York
The Population Council, Inc.
Ndwiga, Charity
United States, New York
The Population Council, Inc.
Oweya, Erick
United States, New York
The Population Council, Inc.
Hopkins, Jonathan
United Kingdom, London
International Planned Parenthood Federation
Oteba, Lawrence
United Kingdom, London
International Planned Parenthood Federation
Stackpool-Moore, Lucy
United Kingdom, London
International Planned Parenthood Federation
Trossero, Ale
United Kingdom, London
International Planned Parenthood Federation
Nhlabatsi, Zelda
Unknown Affiliation
Simelane, Dudu
Unknown Affiliation
Muketo, Esther
Unknown Affiliation
Chatuluka, Mathias G.
Unknown Affiliation
Statistics
Citations: 19
Authors: 36
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0146694
ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Locations
Eswatini
Kenya