<p>Clinic staff database.</p>

Increasing HIV testing and counselling (HTC) is a first step to reducing HIV transmission. Implementing HTC in family planning (FP) clinics has been proposed to increase HIV testing coverage in at-risk populations. The Systems Analysis and Improvement Approach (SAIA) was used to improve HTC rates in FP clinics in Mombasa, Kenya. This hypothesis-generating exploratory analysis evaluated the associations between organizational climate characteristics, organizational readiness for implementing change, and successful implementation of HTC. Surveys were conducted with clinic managers and staff from FP clinics implementing SAIA to increase HTC. Likert-style questions were used to characterize organizational climate metrics and organizational readiness for implementing change (ORIC). Linear regression was performed to examine the association between organizational climate metrics, ORIC domains, and two FP client outcomes: 1) percentage of clients receiving pre-HIV test counseling, and 2) percentage of clients tested for HIV. Eleven clinic staff and 10 clinic managers completed the surveys. For clinic staff, higher innovation and flexibility scores were associated with higher change commitment (β = 0.20, CI 0.09-0.31, p = 0.001) and change efficacy (β = 0.17, CI 0.07-0.26, p = 0.002). Higher clinic manager scores for innovation and flexibility were associated with a higher change commitment (β = 0.44, CI 0.04-0.84, p = 0.03). Additionally, clinic managers’ scores for management support (β = 0.25, CI 0.06-0.45, p = 0.01), commitment to facility (β = 0.78, CI 0.60-0.96, p = 0.001), and relative priority (β = 0.24, CI 0.08-0.39, p = 0.004) were positively associated with higher change commitment and change efficacy. In contrast, clinic managers’ scores for tradition were negatively associated with change commitment (β = -0.38, CI -0.75-0.01, p = 0.05). Clinic staff perceptions of management support were positively associated with the proportion of clients counseled for HIV testing (β = 1.20, CI 0.08-2.32, p = 0.04). Support from leadership and innovation/flexibility are important predictors of change commitment and change efficacy. Strong management support may increase the likelihood of successful implementation of SAIA to improve HTC.提升人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）检测与咨询（HIV Testing and Counselling, HTC）服务覆盖率，是降低HIV传播的首要路径。在计划生育（Family Planning, FP）诊所开展HTC服务，被提议用于提升高危人群的HIV检测覆盖率。本研究采用系统分析与改进方法（Systems Analysis and Improvement Approach, SAIA），旨在提升肯尼亚蒙巴萨地区FP诊所的HTC服务覆盖率。 本项生成假设的探索性分析，评估了组织氛围特征、组织变革实施准备度（Organizational Readiness for Implementing Change, ORIC）与HTC服务成功实施之间的关联。研究针对开展SAIA以提升HTC服务的FP诊所的管理人员与医护人员开展了问卷调查，采用李克特式问卷对组织氛围指标与ORIC进行量化表征。 本研究采用线性回归分析，检验组织氛围指标、ORIC维度与两项FP服务受众结局之间的关联：① 接受HIV检测前咨询的受众占比；② 接受HIV检测的受众占比。共有11名诊所医护人员与10名诊所管理人员完成了问卷调查。 针对诊所医护人员而言，更高的创新与灵活性得分与更高的变革承诺（β=0.20, CI 0.09-0.31, p=0.001）和变革效能感（β=0.17, CI 0.07-0.26, p=0.002）显著相关。诊所管理人员的创新与灵活性得分越高，其变革承诺水平也越高（β=0.44, CI 0.04-0.84, p=0.03）。此外，诊所管理人员在管理支持（β=0.25, CI 0.06-0.45, p=0.01）、对所在机构的承诺（β=0.78, CI 0.60-0.96, p=0.001）与相对优先级（β=0.24, CI 0.08-0.39, p=0.004）上的得分，均与更高的变革承诺和变革效能感呈正相关。与之相反，诊所管理人员的传统性得分与变革承诺呈负相关（β=-0.38, CI -0.75-0.01, p=0.05）。 诊所医护人员对管理支持的感知水平，与接受HIV检测前咨询的受众占比呈正相关（β=1.20, CI 0.08-2.32, p=0.04）。领导力支持与创新/灵活性是变革承诺和变革效能感的重要预测因子。强有力的管理支持，或可提升SAIA成功实施以改善HTC服务的可能性。