HIV/SRH Integration: A HIV Prevention Imperative Lessons from LVCT, Kenya

1. HIV/SRH Integration: A HIV Prevention Imperative Lessons from LVCT, Kenya Nyasuna, G., Otiso, L., Njoroge, I., Ng’ang’a, J., Kilonzo, N. Presenter Gladys Nyasuna IAC Satellite Session: Monday 23rd July 2012 Rhetoric to Reality: Delivering Integrated HIV and Family Planning Services (PAI, FHI 360, EngenderHealth, JSI)

2. The Kenyan Context • Beautiful country; 38.6M people • Constitution: right to health, RH • 7.1% HIV prevalence (15-64) -1.4M PLHIV • Mixed HIV epidemic : general, geographic, concentrated ; Gender & age disparities • CPR 46%; TFR 4.6 (KDHS 2008) • FP unmet needs 24% (KDHS 2008) • MMR 488 per 100 live births • Unmet need for FP among HIV infected -50% (KAIS 2007 • HIV prevalence among pregnant women 9.6%, (KAIS 2007) HIV prevalence per province Kenya AIDS Indicator survey, 2007

3. Kenya has made progress in FP/HIV Integration • Increased demand/uptake of FP/HIV services in various settings of integration • Supportive policy environment • Multi-sectoral RH/HIV Integration Committee • MoH Leadership • Integration models tested and evidence utilized to inform and improve national efforts

4. Current Integration Models • Current Integration models focus on health facility based services. These models include: • HTC/FP, STI/HTC, PMTCT/FANC/PNC, FP/CCC, MCH/CCC • A key gap however exists in integration within community health settings • LVCT’s implements HudumaToshaintegrated VCT, follow up and support model within community settings to address this gap

5. The LVCT HudumaTosha Model Effective Referrals & Linkages

6. HudumaTosha Referrals Model HTC Setting Referral Point Client declines CHW escort Phone f/up by CHW PLHIV Community Health Worker Client escorted by CHW HIV +ve client Client declines immediate referral Home visit by CHW Client declines CHW Counsellor phone f/up Telephone Database One2One Bulk SMS Progress reported in follow-up register The Huduma Tosha referral model that utilizes PLHIV community health workers Counsellor/in-charge monthly visit/phone call to referral point

7. HudumaTosha – The Value Add? • Reduces missed opportunities for FP/RH provision • Optimizes opportunities for meeting contraceptive prevalence rate need • Applies task shifting hence strengthens health systems by re-distributing non-curative tasks such as FP provision from facilities to VCT and community health workers

8. Results (Oct 2011– April 2012) Services provided by LVCT in Western Region Screened for Cervical Cancer n= 2,144 FSWs Tested for HIV n= 31,636 Screened for Unmet FP needs n= 15,280 Screened for STIs n= 2,335 FSWs HIV Positive n= 949 (3%) Positive for unmet needs n= 840(5.5%) STI Positive n= 134 (6%) Positive for cervical cancer n= 88 (4%) Linked to FP services: =429(51%) Provided STI treatment: =134(100%) HIV Positive linked to care = 759 (80%) CaCxPositive linked to care: = 67 (76%)

9. Policy Recommendations Donor level: • Deliberate funding focus on HIV/FP integration • Focus on health systems to support effective HIV/FP integration National policy & practice • Implementation of policy guidelines for FP/HIV integration. • Health systems focus - creation of enabling environment for FP/HIV integration. • Population targeting for effective delivery of integrated services with women and young girls and MARPS as a priority • M&E systems - measure FP/HIV integration and effective referral outcomes • Development of research agenda – evidence base for effective models for integration, costs, feasibility etc

10. Thank You LVCT, Nairobi Kenya www.liverpoolvct.org gnyasuna@lvct.org