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ZPCT II Background

Family Planning/HIV Integration in a Large PEPFAR HIV Program – the ZPCT II Experience Prisca Kasonde MD, MMed, MPH Director Technical Support, ZPCT II/FHI 360. ZPCT II Background. Five-year contract funded by PEPFAR through USAID(June 09 – May 14); FHI 360 is the prime partner

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ZPCT II Background

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  1. Family Planning/HIV Integration in a Large PEPFAR HIV Program – the ZPCT II ExperiencePrisca Kasonde MD, MMed, MPHDirector Technical Support, ZPCT II/FHI 360

  2. ZPCT II Background • Five-year contract funded by PEPFAR through USAID(June 09 – May 14); FHI 360 is the prime partner • Supports the Ministry of Health to strengthen and expand HIV related services in five provinces • Objectives include: • Expand and scale up HIV services (CT, PMTCT, ART, MC, Lab & Pharm) • Collaboration with other partners in providing comprehensive HIV services • Capacity building of MOH • Private-public partnership • Integration at all levels

  3. ZPCT II Coverage • ZPCT II Supported Districts: • 6 provinces • 370 public + 17 private HF

  4. Rationale for FP/HIV Integration • High fertility (6.2), high unmet need for FP (27%), high HIV prevalence (14.3%) and high maternal mortality ratio (470/100, 000 live births) in Zambia • FP is important to PMTCT and reducing the incidence of paediatric HIV • HIV services provide an opportunity to reach people living with HIV with FP information and services • Family planning services also provide an opportunity to increase access to HIV CT and other HIV services

  5. Rationale for FP/HIV Integration • Maximizing the limited HR • Reducing the unmet need for FP is a key objective of the Zambian national PMTCT guidelines. • Integrated services supported by donors, including PEPFAR

  6. International statements supporting FP and HIV/AIDS linkages • ICPD program of action (UN 1994) • Family planning and HIV/AIDS in women and children (UNFPA, WHO 2004) – • Intensifying HIV prevention (UNAIDS 2005) • Declaration of commitment to HIV/AIDS (UNGASS 2006) • Maputo plan of action (African Union 2006) –

  7. The ZPCT II Approach to Integration • Based on overall systems strengthening • Capacity building of HCWs in government health facilities • FP module part of PMTCT training; orientation done for CT and ART providers • Additionally, some HCWs trained in FP using full package • FP providers trained as HIV counselors • On site hands-on mentorship • Support service provision • FP counseling part of routine ANC/PMTCT services with provision of chosen method if desired • FP counseling part of routine CT and ART services with referrals to on-site FP provider if method desired • CT corners created within FP service areas and provider-initiated testing and counseling (PITC) initiated within FP

  8. The ZPCT II Approach to Integration (2) • Task shifting • Use of lay counselors for HIV CT • Lay counselors also provide group education on FP in ANC and PNC • Ensuring quality of services • On site hands on mentorship • FP included in QA/QI tools • Monitoring and evaluation • Routine monitoring of FP related indicators on a monthly basis and tailoring technical assistance to any gaps identified • Community mobilization • FP messages are part of community mobilization efforts aimed at raising awareness of HIV prevention

  9. Impact of FP/HIV Integration in ZPCT II Supported Facilities • Increase in the number of CT and ART clients referred to FP • Table shows numbers 18 months before and after integration

  10. Impact of FP/HIV Integration in ZPCT II Supported Facilities (2) • Increase in the number FP clients receiving CT services • Table shows numbers 18 months before and after integration

  11. Summary • ZPCT II highlights the feasibility of using a referral-based model to make FP a routine part of HIV care • FP/HIV integration possible by incorporating FP into core systems strengthening interventions • More can be done, including tracking and ensuring that referred clients actually receive desired method • Task shifting necessary in resource limited settings • Collaboration and leveraging different partner resources needs to be strengthened

  12. Lessons for Other PEPFAR Programs • HIV programs can be a platform to provide more holistic, integrated care to women and families affected by HIV • HIV and FP implementing partners can leverage each other to support integration (e.g. training and commodity supplies) • Global support for integration = opportunity to accelerate progress toward HIV goals, better maternal and infant health outcomes, and greater realization of women’s rights

  13. Couple receiving FP counseling

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