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HIV/SRH Integration: A HIV Prevention Imperative Lessons from LVCT, Kenya Nyasuna, G., Otiso , L., Njoroge , I., Ng’ang’a , J., Kilonzo, N. Presenter Gladys Nyasuna IAC Satellite Session: Monday 23 rd July 2012 - PowerPoint PPT Presentation
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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 [email protected]