Monitoring and Evaluating the Integration of Family Planning Services and Methods into Couples Voluntary HIV Counselling and Testing Kalonde Malama 1, Change Kwesele 1, Alexandra Hoagland 1, Annie Lockard 2, Katie Fox 2, Tyronza Sharkey 2, Rachel Parker 3, Amanda Tichacek 3, Mubiana Inambao 1, William Kilembe 2, Susan Allen 3 1 Zambia Emory HIV Research Project, Ndola, Zambia, 2 Zambia Emory HIV Research Project, Lusaka, Zambia, 3 Rwanda Zambia HIV Research Group, Atlanta, GA, United States

Context  70%-90% of new infections in Zambia acquired from spouses  One-half of married HIV-positive people have HIV-negative spouses Greater than 95% of these ‘discordant couples’ do not know that they are discordant.  TFR = 5.3 births per woman  Contraceptive use among married women Any Method – 49% Modern Methods: 45 % (Injectables =19%, pills = 12%, implant= 6%, IUD = 1%)  More than one-half of new HIV infections in Africa can be averted through joint testing and counseling -- Couples’ HIV Voluntary Counseling and Testing (CVCT).  Integrating CVCT with Couples’ Family Planning and Counselling (CFPC) and long acting reversible contraceptives (LARC) has added benefits.

ZEHRP with UK DFID Support Funded to scale-up CVCT in Government of the Republic of Zambia (GRZ) Clinics and integrate it with CFPC and LARC to: 1.Prevent HIV infection 2.Prevent Unplanned Pregnancies

Integration of CVCT, CFPC and LARC Developed CFPC and LARC modules and trained providers Established mutual referral systems in 54 urban government clinics in Zambia Couples accessing CVCT referred for LARC Women accessing family planning services referred for CVCT with their partners Established integrated promotions strategies

What do we consider integration? 1.If a couple requests a LARC method on the day of CVCT/CFPC; 2.If CVCT clients report current LARC use; or 3.If a woman requesting LARC reports prior CVCT/CFPC with her partner.

Measuring Integration Unique IDs are assigned to couples accessing CVCT/CFPC services and a separate ID to women accessing LARC in family planning clinics IDs and questions on data collection forms are used to determine if individuals access both services

Scenario 1: On the day they receive CVCT couples also request a LARC method. Data collected: CVCT ID FPID Current Contraceptive Method Method inserted/ removed/ replaced today Nurse Initials

Percent of non-pregnant clients who request a LARC Method at their CVCT M0 Visit

Scenario 2: Women attending CVCT with their spouse are asked if they are already using a LARC method. Data collected: CVCT ID FP ID Current contraceptive method

Percent of non-pregnant couples in which women report already using LARC at CVCT MO

Scenario 3: Women accessing family planning services are asked if they have previously tested for HIV with their spouse. Data collected: FP ID Have you been tested with your partner? CVCTID Month and Year when tested together Current Contraceptive Method Method inserted/ removed/ replaced today Nurse Initials

LARC Clients who report previous CVCT, October September 2015

Conclusion An integrated model of sexual and reproductive health provides an opportunity to tackle HIV prevention, unplanned pregnancy and perinatal transmission of HIV. Integration of CVCT/CFPC/LARC is possible with mutual referral and integrated promotions. Data collection tools can be designed to monitor and evaluate client uptake of integrated services.

Next Steps GRZ has piloted data collection tools which integrate family planning, HIV testing and couples. We urge that these be rolled out nationwide and be used to inform the scale-up of integrated services. The data collected can also be used to secure buy- in for integrated sexual and reproductive health programs, among relevant Ministries and NGOs.