Global HIV/AIDS Initiatives (GHIs) in Zambia
How HIV/AIDS scale-up has impacted on non- HIV
priority services in Zambia?
Joseph SimbayaAisling Walsh
Phillimon NdubaniPat Dicker
Ruairi Brugha
Zambia backgroundHIV prevalence estimate: 14.3%
74% of HIV funding from external donors (mainly Global Fund and PEPFAR)
US$ 6 per capita (2003) to US$ 10 (2006) for HIV control
concerns about the effects of large levels of HIV funding on non-HIV services
Study Objective
Assess the effect of HIV/AIDS scale-up on non-HIV service delivery and coverage
MethodsReview of 39 health facility client record trends from 3 districts covering 2004-07
Intra-facility analyses to compare service trends within facilities how are non-HIV services performing
in facilities where HIV scale-up is happening?
Spearman rank correlations measured.
Scale-up in ART, VCT, PMTCT client nos.
Year
2004 2005 2006 2007
Clie
nts
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
ART Clients (24 facilities)VCT Clients (21 facilities)PMTCT Clients (16 facilities)
ART Coverage 2004 to 2007Year N Numerator Denominator Coverage
2004 16 5018 24861 20.2%
2005 16 13113 26657 49.2%
2006 16 21947 28551 76.9%
2007 16 22811 30433 75.0%
Trends in infant vaccination and ART, 2004-07
Year
2004 2005 2006 2007
Clie
nts
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
55000
60000
ART Clients (24 facilities)DPT3 Vaccinations (27 facilities)BCG Vaccinations (28 facilities)
49261 49770
56571 56107
31290 34594
41609
42717
8843
21267
33016
44311
Reproductive health service coverage
Year
2004 2005 2006 2007 *
Pe
rce
nt
0
5
10
15
20
ANC (29 facilities)FP (29 facilities)
* includes 32 facilities for 2007
41814 (15.9%) 41798 (15.4%) 44239 (15.8%)
46656 (16.2%)
54683 (16.7%)
30120 (11.5%) 37093 (13.7%)
31795 (11.4%) 33653 (11.7%)
37794 (11.6%)
Intrafacility correlations between HIV and non-HIV services, 2005-07 (rank correlations > 0.3 highlighted).
Facilities reportingClients for two services
Number of facilities
Spearman Rank Correlation (positive unless otherwise stated)
ART and Antenatal Clinic 9 0.22
ART and Family Planning Clinic 9 0.83
ART and DPT 3 vaccine 9 0.00
ART and BCG vaccine 9 0.27
PMTCT and Antenatal Clinic 12 0.50
PMTCT and Family Planning Clinic 12 0.33
PMTCT and DPT 3 vaccine 12 - 0.11
PMTCT and BCG vaccine 12 0.14
VCT and Antenatal Clinic 11 0.12
VCT and Family Planning Clinic 11 0.38
VCT and DPT 3 vaccine 11 0.15
VCT and BCG vaccine 11 - 0.30
Correlation in ART and Family Planning service trends, 2005-07
ART clients % change
0 100 200 300 400 500 600
FP
Clie
nts
% c
ha
ng
e
40
60
80
100
120
140
160
180
200
Spearman Rank Correlation=0.83 (9 facilities)
Correlation in VCT and Family Planning client trends, 2005-07
VCT clients tested % change
0 200 400 600 800 1000
FP
Clie
nts
% c
ha
ng
e
40
60
80
100
120
140
160
180
200
Spearman Rank Correlation=0.38 (11 facilities)
ConclusionsPositive associations between HIV and
non-HIV scale-up supports hypothesis that HIV funding has positive systems effects.
Further research needed:replicate this approach in larger
representative samples in other settings.Explanatory studies, interviewing health
workers and managers, to understand what health systems factors contribute to positive and negative synergies between priority services
Collaborating InstitutionsFunders
Open Society InstituteDANIDAIrish Aid
Implementing InstitutionsFrontiers Development and Research GroupInstitute of Economic and Social Research,
University of ZambiaCollaborating Institutions
Royal College of Surgeons in IrelandLondon School of Hygiene and Tropical Medicine