INTEGRATING SEXUAL REPRODUCTIVE HEALTH AND HIV/AIDS SERVICES

1. INTEGRATING SEXUAL REPRODUCTIVE HEALTH AND HIV/AIDS SERVICES

2. Demographic information • Kenya Population – 30 million (census 99) • MMR – 414/100,000 live births • Infant Mortality Rate – 77/1,000 live births • CPR – 39% • TFR – 4.9

3. Demography cont. • 56% of sexually assaulted are below 15yrs • 50% of new HIV/AIDS infections occur among the youth (15-24 years) • Regional disparity highest in Nyanza province (14%, Suba District 34%), lowest in Eastern (4%) and North Eastern (0%) provinces

4. CPR and TFR in Kenya for currently married women: 1978-2003 Source: KDHS 1978-2003

5. Strong Gender DimensionsHIVPR among women and men15-49 Years Source : KDHS 2003

6. Access to HIV/AIDS services • Access to HIV testing has improved with the rapid expansion of VCT sites, currently 600 • Access to ART, About 70,000 HIV Positive clients currently on ARVS against the 2OO,OOO eligible • Currently 2080 PMTCT Sites • HBC Care services, mainly through CBOs in different parts of the country

7. Integration What is integration?

8. Integration Definition “Offering two or more services at the same facility during the same operating hours, with the provider of one service actively encouraging clients to consider using the other services during the same visit in order to make those services more convenient and efficient”

9. FP/VCTIntegration Definition: This is the incorporation of some or all of FP services into VCT services

10. Rationale for Integrating RH and HIV/AIDS Services • HIV/AIDS and FP services • target the same population of sexually active individuals • common route of entry (sex): pregnancy & HIV • have many similar desired outcomes

11. Rationale for Integrating RH and HIV/AIDS Services cont… • Rapid increase of resources for VCT/PMTCT programs in country due to global focus • Good quality FP services have great potential for reducing MTCT of HIV/AIDS

12. Rationale Cont. • HIV/AIDS services such as VCT attract a broader range of clients including men/youth who would benefit from FP services • Reduce missed opportunities

13. Rationale Cont. • In a context of limited resources like ours integration is a cost effective and sustainable approach and provides SYNERGY of actions

14. TYPES OF INTEGRATION OF HIV/ RH SERVICES At Facility level: • FP in VCT • CT in FP • FP/STI in CCC • FP in PMTCT • Integrated Youth Friendly Services • Comprehensive Post rape care services

15. Types Cont…. Community level: • FP in HBC to PLWHA • HIV in CBD program

16. Models of FP and HIV Integration • Family Planning into VCT • Counseling and Testing into FP

17. Levels of FP/VCT Integration Level 1:Condoms and pills LEVEL 11: Condoms, pills and injectables LEVEL 111: Condoms, pills, injectables and IUCD LEVEL IV: A full range of contraceptive methods

18. Levels of CT/FP Integration • Level 1: (Referral) Includes the provision of information about CT to new and repeat FP clients with referral for those that are interested.

19. Levels of CT/FP Integration • Level 2 (testing model) Includes on-site testing and post-test counselling of FP clients, rather than referring for CT

20. Components of the two programmes that can be integrated Source: MOH, Draft Strategy for the Integration of HIV-VCT and FP Services

21. Enabling factors for Integration • Supportive policy environment, NHSSP 11 emphasis on delivery of integrated KEPH for all life-cycle cohorts

22. Enabling factors for Integration cont… • MOH structure conducive; • HIV/AIDS and FP exist as components of the country’s RH strategy • Existence of the relevant technical committees

23. Enabling Factors cont. • Existence of service provision policy and guidelines • RH Policy, FP, VCT, ASRH and PMTCT , Medical management of sexual violence survivors guidelines includes both HIV guidelines etc

24. Integration requires • A conducive policy environment • Service protocols and training materials • Strong health management systems • Training for service providers and managers • Moving from IEC to BCC • Restructure institutions

25. Is Integration Worth the effort? • FP-PMTCT -A recent USAID-funded analysis estimated that by the year 2007,32000 child infections,55,000 child deaths and 155,000 orphans could be prevented and 7000 mothers lives could be saved in 14 high HIV prevalence countries by adding family planning to PMTCT, thus doubling the effectiveness of PMTCT programs

26. CONTD • The recent USAID-Funded analysis indicated that by adding Family planning to PMTCT, the cost of each HIV infection averted would be an estimated $660 as compared to $1300 per infection averted with PMTCT alone. Similarly ,the cost of each child death averted would be estimated$360, as compared to $2600 with PMTCT alone.[ Stover et al ]

27. CONTD • Increasing use of contraceptives among women who do not want to get pregnant is at least as cost-efficient for PMTCT as increasing the coverage of prenatal care programs that offer nevirapine to HIV –infected women. [Reynolds ET AL] • Preventing pregnancy in HIV-positive women or slightly decreasing Adult HIV prevalence are estimated to be as effective in reducing HIV-positive births as treating HIV mothers with Nevirapine[Sweat et al]

28. Opportunities for RH in the era of HIV/AIDS • Resources for HIV/AIDS programs have been on the increase over the last few years • Majority of those targeted by HIV/AIDS programs are people with RH needs

29. Opportunities for RH in the era of HIV/AIDS cont.. • Expansion of HIV/AIDS programs, especially VCT and PMTCT provides an opportunity for linkage with RH Services

30. Opportunities for RH in the era of HIV/AIDS cont.. • Linking RH to VCT services is a good strategy for increasing access to RH services for young, sexually active men and women.

31. PRIORITY AREAS FOR INTERGRATION • Safe Motherhood and Neonatal Health • ASRH • Family Planning • Post Rape care

32. Infection prevention practices Appropriate infrastructure Lack of appropriate knowledge by both providers and clients Negative attitudes amongst providers Shortage of staff Challenges of service provision