HIV/SRH Integration: A HIV Prevention ImperativeLessons from LVCT, Kenya

Nyasuna, G., Otiso, L., Njoroge, I., Ng’ang’a, J., Kilonzo, N. Presenter

Gladys Nyasuna

IAC Satellite Session: Monday 23rd July 2012Rhetoric to Reality: Delivering Integrated HIV and Family Planning Services

(PAI, FHI 360, EngenderHealth, JSI)

Beautiful country; 38.6M people Constitution: right to health, RH 7.1% HIV prevalence (15-64) -

1.4M PLHIV Mixed HIV epidemic : general,

geographic, concentrated ; Gender & age disparities

CPR 46%; TFR 4.6 (KDHS 2008) FP unmet needs 24% (KDHS

2008) MMR 488 per 100 live births Unmet need for FP among HIV

infected -50% (KAIS 2007 HIV prevalence among pregnant

women 9.6%, (KAIS 2007)2

Eastern 4.6%

North Eastern 0.8%

Rift Valley 6.3%Western 5.4%

Nyanza 14.9%

Nairobi 8.8%

Coast 8.1%

Central 3.6%

HIV prevalence per provinceKenya AIDS Indicator survey, 2007

The Kenyan Context

• Increased demand/uptake of FP/HIV services in various settings of integration

• Supportive policy environment • Multi-sectoral RH/HIV Integration Committee• MoH Leadership• Integration models tested and evidence utilized to

inform and improve national efforts

Kenya has made progress in FP/HIV Integration

• Current Integration models focus on health facility based services. These models include:

› HTC/FP, STI/HTC, PMTCT/FANC/PNC, FP/CCC, MCH/CCC

• A key gap however exists in integration within community health settings

• LVCT’s implements Huduma Tosha integrated VCT, follow up and support model within community settings to address this gap

Current Integration Models

HIV Testing and Counselling (HTC)

Stand Alone sites, HBTC, Mobile &Workplace HTC

TB Screening

STI & Cervical Cancer

ScreeningFamily

Planning Services

Alcohol Screening

Other Prevention

/ EBIs

HIV risk profiling

The LVCT Huduma Tosha Model

Effective Referrals &

Linkages

Huduma Tosha Referrals Model

Referral Point

PLHIV Community

Health Worker

HIV +ve client

HTC Setting

Client declines CHW Telephone Database

Counsellor phone f/up

One2One Bulk SMS

Phone f/up by CHW

Home visit by CHW

Client declines CHW escort

Client escorted by CHW

Counsellor/in-charge monthly visit/phone call to referral pointProgress reported in follow-up register

Client declines immediate referral

6

The Huduma Tosha referral model that utilizes PLHIV community health workers

Huduma Tosha – The Value Add?• Reduces missed opportunities for FP/RH provision

• Optimizes opportunities for meeting contraceptive prevalence rate need

• Applies task shifting hence strengthens health systems by re-distributing non-curative tasks such as FP provision from facilities to VCT and community health workers

7

Results (Oct 2011– April 2012)Services provided by LVCT in Western Region

Tested for HIV n= 31,636

Screened for Unmet FP needs

n= 15,280

Screened for STIsn= 2,335 FSWs

Screened for Cervical Cancer n= 2,144 FSWs

HIV Positiven= 949 (3%)

Positive for unmet needsn= 840(5.5%)

STI Positiven= 134

(6%)

Positive for cervical cancer

n= 88 (4%)

HIV Positive linked to care = 759 (80%)

Linked to FP services:

=429(51%)

Provided STI treatment: =134(100%)

Ca Cx Positive linked to care:

= 67 (76%)

Policy Recommendations

Donor level:• Deliberate funding focus on HIV/FP integration• Focus on health systems to support effective HIV/FP integrationNational policy & practice• Implementation of policy guidelines for FP/HIV integration. • Health systems focus - creation of enabling environment for

FP/HIV integration. • Population targeting for effective delivery of integrated services

with women and young girls and MARPS as a priority• M&E systems - measure FP/HIV integration and effective

referral outcomes• Development of research agenda – evidence base for effective

models for integration, costs, feasibility etc

Thank You

LVCT, Nairobi Kenyawww.liverpoolvct.orggnyasuna@lvct.org