Feasibility and effectiveness of integrating provider-initiated testing and counselling within family planning services in Kenya

Objective:To assess an intervention for increasing access to and use of HIV testing among family planning clients through provider-initiated testing and counselling for HIV. Design:Two versions of the intervention were prospectively compared using a prepost intervention only design. Health facilities were purposively selected and family planning consultations randomly selected. Setting:Twenty-three public-sector hospitals, health centres and dispensaries in two districts of Central Province, Kenya. Participants:One group of 28 family planning providers were trained in the integrated family planning–HIV counselling intervention and in providing HIV testing and counselling to family planning clients requesting a test during the consultation and another group of 47 family planning providers were trained in the intervention and in referring clients interested in an HIV test. Samples of family planning clients willing to be observed and interviewed were randomly selected (538 preintervention, 520 postintervention) and their informed consent obtained to observe their consultation. Intervention:All family planning providers were trained in an algorithm that integrates HIV/sexually transmitted infection prevention counselling, including offering HIV testing and counselling, with family planning counselling. Clients choosing to be tested were either referred or tested during the consultation by a trained family planning provider. Main outcome measures:The proportion of family planning clients with whom HIV testing was discussed; the proportion offered HIV testing; and the proportion choosing to have a test. Results:The proportion of consultations in which HIV prevention counselling was provided and HIV testing offered increased significantly. The proportion of clients requesting an HIV test increased from 1 to 26%; approximately one third of these had never been tested previously. Conclusion:Provider-initiated testing and counselling is feasible and acceptable in family planning services, does not adversely affect the quality of the family planning consultation and increases access to and use of HIV testing in a population who would benefit from knowing their status.