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Open Access Research article

Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

Nicole HTM Dukers-Muijrers12*, Carlijn Somers1, Christian JPA Hoebe12, Selwyn H Lowe24, Anne-Marie EJWM Niekamp12, Astrid Oude Lashof24, Cathrien AMVH Bruggeman23 and Hubertus JM Vrijhoef35

Author Affiliations

1 Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, P.O. Box 2022, 6160 HA, Geleen, The Netherlands

2 Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands

3 Department of Integrated Care, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

4 Department of Internal Medicine, section Infectious Diseases, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ, Maastricht, The Netherlands

5 School of Social and Behavioural Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands

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BMC Public Health 2012, 12:1118  doi:10.1186/1471-2458-12-1118

Published: 27 December 2012

Abstract

Background

Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration.

Methods

The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254), and quality rating.

Results

Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good.

Conclusions

The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.

Keywords:
HIV; Quality of care; Services integration; Public health care; Hospital care; STI