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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;


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

  • 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: 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;



Quality HIV testing and counselling

Linking testing to care,



Serving vulnerable/at risk populations:




Survivors of SV

Technical support to Govt.

Policy reforms action:

- National strategies

- Standards & indicators

- Policy implementation

Health & Community


- 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


Evidence to ACT:

  • Research
  • Piloting
  • Platforms to ACT:
  • Policy reforms
  • Systems strengthening
  • Partnerships



mental Justice outcomes


  • Impetus to ACT:
  • Quality service delivery
  • Client feedback


LVCT’s GBV/ PRC action framework

2003 4 hiv and sv
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

  • 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)

  • Stakeholder consultations: DRH, local HMTs
  • Standard of care: algorithm,protocols, procedures
  • Provider training
  • Community mobilization

Emergency management

PEP/EC, examination, PRC1 form

STI drugs


Counseling - Trauma/crisis, HIV test,

PEP adherence; preparation for

Justice system


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..

  • 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


  • 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

  • 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..

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