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