Costs and Efficiency of Integrating Family Planning into Anti retroviral Therapy Services in Zambia: A Mixed Method Comparison of the Fully Integrated Versus Referral Models

Abstract

Background: Integrating HIV and family planning (FP) services can improve health outcomes, continuity of care, and efficiency. However studies on its cost-efficiency are lacking. The objective of this study is to assess and compare the cost-efficiency of two models of FP/HIV integration in Zambia. Methods: We considered two integration models - "internal referral" (IR), where patients receive FP counselling within the HIV clinic and a referral to the FP clinic in the same facility for FP method, and "one-stopshop" (OSS), where patients receive FP counselling and a FP method within the HIV clinic. We compared the efficiency of the models using the unit cost per antiretroviral therapy (ART) patient provided with FP services. We also computed the percentage of missed opportunities for FP services provision; when patients with identified FP needs are not offered services. Results: The unit costs per patient provided with FP method was USD $261 on average for the OSS model and USD $267 on average for the IR model. We found no statistically significant difference in unit costs between the two models (P=0.36). On average, the OSS model had 25 percent missed opportunities for FP counselling compared to 33 percent for the IR model but the difference was also not statistically significant (P=0.3). Conclusion: A fully integrated model of FP/ART services (OSS) is not necessarily more cost-efficient than the referral model as the performance of each depends on the service delivery settings.