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FP/RH and HIV/AIDS(VCT/PMTCT) Integration: Advance Africa’s experience. Kwaku Yeboah MB,CHB; MPH Arlington, November 18, 2004. Outline of presentation. Overview of RH/HIV/AIDS Integration RH/HIV challenge Definition/Why integrate? Levels/models of integration Advance Africa’s experience

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fp rh and hiv aids vct pmtct integration advance africa s experience

FP/RH and HIV/AIDS(VCT/PMTCT) Integration:Advance Africa’s experience

Kwaku Yeboah MB,CHB; MPH

Arlington, November 18, 2004

outline of presentation
Outline of presentation
  • Overview of RH/HIV/AIDS Integration
    • RH/HIV challenge
    • Definition/Why integrate?
    • Levels/models of integration
  • Advance Africa’s experience
  • Way forward
the reproductive health challenge
The Reproductive Health Challenge
  • Enormous task in tackling unmet needs of RH in developing world
    • Over 120 million women have unmet need for FP
    • 350 million women lack access to full range of contraceptive methods
    • 120,000 HIV + women get pregnant each year
    • # of young people 10-24 yrs increased by 50% in 30 yrs
    • Between 1994 and 2015, 3 billion people will enter reproductive years
    • 500,000 women die a year from pregnancy related causes
hiv aids challenge
HIV/AIDS Challenge
  • 40 million people worldwide; approx.70% in SSA
  • 14,000 new daily infections ( mainly through sexual contact) {UNAIDS}
  • Women and young people especially vulnerable
    • 50% new infections in 15-24 yr olds
    • 50% new infections among women
  • Annually 1.8 million infected pregnant women deliver approx 600,000 infected infants (UNICEF)
effect of unmet need and high hiv prevalence
Effect of unmet need and high HIV prevalence
  • Estimated 20 million women living with HIV
  • 25% of women with an unmet need for contraception
  • Therefore an estimated 5 million HIV positive women are in need of contraception
integration defined
Integration defined
  • “arrangement for the provision of multiple but related services concurrently during a same visit”
    • Provider of one service actively encourages clients to use other services during the same visit
why integrate rh and hiv aids programmes
Why Integrate RH and HIV/AIDS Programmes?
  • FP and HIV/AIDS services are both elements of reproductive health care, aimed at improving reproductive health of individuals.
  • FP is a key strategy in reducing vertical transmission of HIV.
  • To maximize use of scarce financial and human resources, and respond to client needs by offering services to meet multiple needs of clients
why integrate 2
Why integrate? (2)
  • Both have similar socio cultural determinants
  • Both programmes serve essentially same target groups.
  • Both rely on effective prevention.
  • Both promote responsible sexual behavior among others.
  • Both require and use similar medical/health skills and /or facilities.
  • Both address sensitive sexuality issues
levels of integration
Levels of integration
  • Policy
    • Provides framework and enabling environment
  • Programmatic
    • Gives the clear direction of the “how”( reduce missed opportunities)
  • Service delivery
    • Institutional arrangements/ community involvement and participation
models of integration
Models of integration
  • High integration
    • Services in same physical location
    • Services in same institution but different physical locations
  • Low integration
    • Services in different institutions but linked by pre arranged mechanism
prevention of mother to child transmission strategy unaids who
Prevention of Mother to Child Transmission Strategy (UNAIDS/WHO)

Prevention of HIV in women, especially young women

Prevention of unintended pregnancies in HIV-infected women

Prevention of transmission from an HIV-infected woman to her infant

Support for mother and family

Phase 1

Phase 2

Phase 3

Phase 4

prevention of unintended pregnancies among hiv women how
Prevention of unintended pregnancies among HIV + women. How?
  • Meet unmet need for contraception
  • Bring services closer to HIV + women
    • VCT, PMTCT, ARV treatment programmes, HBC
  • Address special needs of HIV + women currently using FP
what did advance africa do
What did Advance Africa do?
  • Development of strategy
  • Advocacy for integration
  • Assessment of sites for demonstration projects
  • Participatory planning
  • Capacity building
  • Supervision
  • M&E
  • Work with already existing VCT/PMTCT/PMTCT Plus programs
    • Chelston clinic
    • MOH, Mozambique
    • 3 Mission hospitals in Zimbabwe
  • Use already existing service delivery arrangements
  • Harness community mobilization for demand generation
  • “Why FP matters” developed
  • Personal contacts with appropriate authorities in demonstration sites
  • Advocacy seminar in Harare – Sept 2003
    • Targeted heads and key staff of demonstration hospitals
    • About 65 participants involved
assessment of sites
Assessment of sites
  • Objective was to determine current status of RH/FP and HIV/AIDS as it relates to:
    • Access – service delivery arrangement and cost
    • Quality – numbers trained in FP and when, any refresher training, equipment, method mix etc
    • Demand for services – community mobilization
    • Sustainability – ownership, partnerships, collaboration
participatory planning
Participatory planning
  • What to do
  • Target groups
  • How to undertake these without disruption of services
  • Time line
  • Indicators
      • Product: detailed plan for each site
capacity building
Capacity building
  • Development of curriculum
    • Focus on special contraceptive needs for HIV + women, dual protection and WHO medical eligibility criteria.
  • HR – training needs assessment in Zimbabwe
  • Training – 5days theory to be followed up with clinical practice
    • 16 trainees from 3 hospitals in Zimbabwe
    • 28 trainees from 10 provinces in Mozambique
    • 25 trainees from Chelston and 4 surrounding clinics
  • Technical supervision planned for trainees
capacity building 2
Capacity building-2
  • Commodity security
    • Reviewed current system and added additional resources for additional quantities of contraceptives to ensure wider method mix
  • Data management
    • Orientation of relevant staff in data entry and analysis
    • Provision of PC to facilitate data management
  • Community outreach strengthening
    • Resources for more outreach
    • Additional depot holders recruited in Zimbabwe
method mix by hiv status all 3 sites
Method Mix by HIV status ( all 3 sites)

Condoms are both male and female

lessons learnt
Lessons learnt
  • Advocacy seminar sought to clarify the concept of integration
  • Participatory planning allowed the hospitals to identify the best ways of implementing the integration
  • Trainees have developed confidence in providing FP for HIV + women
  • Clear guidelines on reporting enhanced data collection
  • Community component very crucial
challenges to integration
Challenges to integration
  • Policy issues( e.g restriction on certain service provision by certain categories of HCWs)
  • May create additional burden on providers
  • May meet resistance by service providers
  • Existing parallel programmes may resist integration
  • Continuous availability of RH commodities
  • Community perceptions/commitment
what is the future for aas integration efforts
What is the future for AAs integration efforts?
  • All resources will be widely disseminated as part of the close out of the project
  • A thorough write up of the experience with all relevant documentation will be made available to integration working group for dissemination
  • Specific best practices will be documented
  • Integrating FP/RH and HIV/AIDS programmes have great benefits to providers and clients
  • Political will, commitment and change in orientation is required to ensure that integration happens
  • Challenges are inevitable but can be overcome
  • Integrating FP/RH and HIV/AIDS services is feasible in spite of HR and financial constraints.