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From Evidence to Programming: GBV in the HIV and AIDS response

From Evidence to Programming: GBV in the HIV and AIDS response. Maureen Obbayi ; Nduku Kilonzo PhD; Lina Digolo MbChB ; Lilian Otiso MbChB The LVCT GBV/PRC team; The Division of Reproductive Health/Ministry of Public Health and Sanitation

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From Evidence to Programming: GBV in the HIV and AIDS response

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  1. From Evidence to Programming: GBV in the HIV and AIDS response Maureen Obbayi; NdukuKilonzo PhD; LinaDigoloMbChB; LilianOtisoMbChB The LVCT GBV/PRC team; The Division of Reproductive Health/Ministry of Public Health and Sanitation Trocaire; The Elton John AIDS Foundation; PEPFAR/USAID

  2. 40M people • Constitution: right to health, RH • 7.1% HIV prevalence (15-64) • Mixed HIV epidemic: general, geographic, concentrated; Gender & age disparities • Sexual violence: limited data; high prevalence - 1 in 5 women experience sexual violence (SV)

  3. LVCT: an indigenous Kenyan NGO, country led, country managed, country priorities LVCT - inputs - Innovation - New service delivery models Coverage - access, equity (in both delivery and uptake); Strengthened health systems; New knowledge; Research/ Piloting Quality HIV testing and counselling Linking testing to care, prevention, SRH Serving vulnerable/at risk populations: MSM Youth PWDs Survivors of SV Technical support to Govt. Policy reforms action: - National strategies - Standards & indicators - Policy implementation Health & Community systems - LVCT Training Institute - Quality assurance of services - Programme data utilization - CSO coordination frameworks - TIMISHA (LVCT South to south capacity building model) - Direct service delivery - Demand creation & advocacy Scale up

  4. Evidence to ACT: • Research • Piloting • Platforms to ACT: • Policy reforms • Systems strengthening • Partnerships Research ACTION: HIV, SRH, mental Justice outcomes Policy • Impetus to ACT: • Quality service delivery • Client feedback Practice LVCT’s GBV/ PRC action framework

  5. 2003/4: HIV and SV? • Survivors of sexual violence? • VCT counsellors from Quality Assurance • Emerging PEP data • Operational research study (2004-6) • Diagnosis: perceptions, priorities for service delivery • Intervention: standard of care, health provider training • Evaluation: uptake and delivery of care (prophylaxis, examination, counselling) Kilonzo et al, 2007; 2008; 2009

  6. Diagnosis • No regulatory framework, standards or reporting • Inconsistent service delivery, limited capacities • Perceptions: “Lets say I have a boyfriend and am against the act, but you can be forced. He will come at night when he knows I am there because he want to do …, and to make me to give him. He knows if he rapes me... and when others get to know, they will reject and laugh at me saying I was raped – so I will give in” (adolescent female, 16yrs, Thika)

  7. Intervention • Stakeholder consultations: DRH, local HMTs • Standard of care: algorithm,protocols, procedures • Provider training • Community mobilization Emergency management PEP/EC, examination, PRC1 form STI drugs CASUALTY/OPD Counseling - Trauma/crisis, HIV test, PEP adherence; preparation for Justice system Laboratory on-going follow up 4/52 HIV care: PEP management: Laboratory monitoring PEP outcomes

  8. Data for programming.. • median age - 16.5; 56% children; 88% female • 55% - knew assailant, children more likely (OR 6.2; p=0) • 82% EC delivery • 16% lost in client flow • Changes: • Child friendly services (Speight et al 2006) • EC services at casualty • Social support & counselling • Strengthening referrals Evaluation in 2006(n=386; >30% data rejected)

  9. 2012.. • 84 service sites • > 1,000 health providers trained • 15,000 survivors seen • GAPS • No knowledge of costs of scaling up PRC by DRH • Poor medico-legal linkages • Effectiveness of PRC kit for justice unknown; referrals poor • Poor PEP adherence/ SRH outcomes and retention of survivors in health care from evidence to programming: research-policy-practice 2006: - guidelines; training curricular; MOH 263 (PRC 1) medico-legal form PRC 1: 2004 /06 - Service delivery model tested 2006: Costing of scale up of PRC services 2007: DHR Scale up plan with PRC indicators COE1: 2007 /10: Model for chain ofevidence tested 2009/10: -guidelines 2nd edition 2011/11: PRC kit effectiveness evaluated 2011-13: aim- to strengthen medico-legal framework (SOA) 2012/14: QA & survivor retention, SRH/HIV outcomes evaluated

  10. Lessons.. • HIV programmes(funds, systems, political focus) an opportunity for GBV with good monitoring in-built • Investment in internal and local real capacity for: monitoring, evaluation and research • Implementation science located in localsystems (e.g. commodities & supplies), structures (e.g. reporting) • Health sector growth must be aligned to other sectors (justice, law, order)

  11. Some key arguments.. PRC costing study – US$ 26 per survivor • Invest in partnerships – are key for policy reforms action which results in research utilization • Resource data is essential to mobilize investment, political attention • ‘Evaluationof service delivery’ - works with funding partners

  12. Thanking all these great individuals…

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