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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

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


  • 40M people response

  • 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)


Lvct inputs

  • LVCT: a responsen 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


  • 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


2003 4 hiv and sv
2003/4: HIV and SV? response

  • 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


Diagnosis
Diagnosis response

  • 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)


Intervention
Intervention response

  • 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


Evaluation in 2006 n 386 30 data rejected

  • Data for programming.. response

  • 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)


F rom evidence to programming research policy practice

  • 2012.. response

  • 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


Lessons
Lessons.. response

  • 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)


Some key arguments
Some key arguments.. response

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



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