1. Using Facilitated Referrals to Integrate Family Planning Services into HIV Care and Treatment Clinics in Tanzania Mackenzie S. Green, Mark A. Weaver, Thecla W. Kohi, Stella N. Mujaya, Christine Lasway, Gottlieb Mpangile, Joy Noel Baumgartner

2. Background 2006 FHI assessment found high levels of unmet need among sexually active ART clients 2008 MOHSW request to FHI to develop and test a facilitated referral model – Joint request from National AIDS Control Programme and Reproductive and Child Health Section Facilitated referrals are enhanced referrals for additional services – Consist of specific actions to encourage completion of the referral

3. Facilitated Referral Model 1. SCREEN 2. COUNSEL 3. REFER 4. RECORD 5. ACCOMPANY 6. ACCESS 7. MONITOR FPFP CTCCTC Screen clients to learn fertility intentions and current FP use Provide minimal counselling on FP options or on safer pregnancy Refer clients with need to FP clinic and Record referral Accompany clients to FP clinic Clients with referrals access FP services

4. Intervention Elements Service Delivery Guidelines Site Assessment Visit Training –2 days for CTC staff –3 day for FP staff –1 day CTC & FP In-Charges Job Aids Recording Codes Supportive supervision

5. Intervention Facilities 12 intervention facilities – FHI-supported care and treatment programs – Includes hospitals and health centers Selected for: – High CTC client load – Co-location of CTCs with FP clinics

6. Evaluation Study Quasi-experimental Pre- and post-test Cross-sectional CTC clients – Women, 18-45 years, WHO Stage I-III or CD4>100 – Recruited at CTC; interviewed after all services CTC and FP providers, In-charges

7. Results CTC clients interviewed: – 323 at Baseline; 299 at Post-intervention Characteristics similar among Baseline & Post- intervention women – 3-4% currently pregnant – 35-40% would like another child – 70% on ARVs

8. FP Need Among Non-Pregnant CTC Clients at Baseline and Post-Intervention Percent of Non-Pregnant CTC Clients Post- Intervention (n=291) Baseline (n=309)

9. FP Methods Used by CTC Clients Sexually Active in Last 3 Months

11. Facilitated Referral Process Reported by CTC Clients at Baseline and Post-Intervention Percent CTC Clients

12. Future Planning Screen clients comprehensively Target the right women for referrals Take steps to minimize stigma Ensure functioning referral system Anticipate provider burden Involve men

13. Summary Increase in reported screening, FP discussions, and provision of referrals Positive impact on FP uptake, particularly dual method use Feasible option for integrating services: – Facilities with co-located CTC and FP services – Locations with limited human or other resources – Utilize existing primary health system