1Management Sciences for Health Stronger health systems. Greater health impact. 16 th ICASA Conference – Addis Ababa, 4 th - 8 th December 2011 Author; Acio Jennifer Francesca Co-Authors: Moses Arinaitwe, Dorothy Akurut, Edward Ssemafumu Enhancing Positive Prevention among HIV Sero-Discordant and Concordant Couples through Reproductive Health: The STAR-E Experience

2Management Sciences for Health STAR-E Project overview Five year HIV/TB Project Funded by PEPFAR through USAID Key implementing partner is MSH Assist Government of Uganda Strengthen district-based HIV/TB services. STAR-E supports 12 districts Sites: 141 Health Facilities Total population: 2,439,400 (6.5% of total Uganda population).

3Management Sciences for Health Background to the Intervention Access to RH information and services still a problem among many couples living with HIV/AIDS in rural communities in E. Uganda, hence hindering PP Many WLHIV who desire to postpone, space or limit pregnancies still have an unmet need for safe and effective contraception, hence exacerbating MTCT of HIV WLHIV are at higher risk for cervical cancer than HIV- women due to compromised immunity, hence increased morbidity & mortality The need for RH services is often overshadowed by focus on medical needs of PLHIV, lack of provider time and support, and lack of community awareness and support for RH information and services for PLHIV

4Management Sciences for Health Objective of the Intervention To enhance accessibility, availability and uptake of Reproductive Health services and information among HIV sero-discordant and concordant couples in order to enhance positive prevention

5Management Sciences for Health STAR-E Project Approach Integrative and family focused Integrating RH into traditional PP packages Facilitating community outreaches to promote accessibility and availability to RH services Onsite assessment, screening, and treating WLHIV and their partners for STIs Onsite screening of WLHIV and women in HIV sero- discordant relationships for cervical and breast cancer Linking cancer cases to treatment, care & monitoring in Government health institutions

6Management Sciences for Health Methods A review of medical records to identify 1,000 sero-discordant and concordant positive partners in two phases: Phase 1: Ground breaking 150 (15%) sero-discordant couples with known status were mobilized and counseled Free HIV testing was offered only to the negative partners All the 150 sero-discordant couples were taken through a three days’ communication skills building, and reproductive health training Trained as model couples to enhance communication on Positive Prevention and RH in their communities, and mobilize more peers for services

7Management Sciences for Health Methods continued….. Phase 2: Roll out Total of 485 couples(200 concordant positive;285 sero-disc.) mobilized and taken through one day sensitization on PP &RH Onsite screening for cervical cancer and diagnosis results given Cancer cases registered, assigned to an expert client for follow up and referred to care Onsite assessment, screening and treatment for STIs for couples HCT offered to 180 HIV sero-disc. Negative partners

8Management Sciences for Health Results: Discordant Couples Total of 285 sero-discordant HIV- partners took up free HCT in both phases. 250 women in sero-discordance screened for cervical & breast cancer 35 couples (F-35, M-35) screened and treated for STIs 40 mothers accessed family planning services with their partners A disc. Couple, escorted by an expert client, waiting to undergo cryotherapy A WLHIV undergoing cryotherapy

9Management Sciences for Health Results: Concordant HIV+ Couples 60 HIV positive women of child- bearing age accessed family planning services with their spouses 30 couples were diagnosed and treated for STIs. 200 concordant HIV-positive women screened for cervical & breast cancer. 4 WLHIV diagnosed with cervical cancer and started on cryotherapy. A WLHIV smiles after completing her cryotherapy A discordant couple undergoing HCT

10Management Sciences for Health Conclusion Focusing attention on couples living with HIV & sero-discordant is effective in promoting access to and availability of RH services, and bonds relationships. Any contact with SRH services represents an opportunity for women and their partners to be informed, screened and treated for STI. Services for preventing, diagnosing and treating STIs offer many opportunities for synergy with HIV prevention, care and treatment efforts, and are vital for increasing men’s involvement in RH. Community-owned resource persons are critical in mass community sensitization and mobilization for services, and promote sustainability and community ownership.

11Management Sciences for Health Recommendations Integrating RH education and services in all positive prevention activities, and prioritizing services that can attract men to take up RH issues. controlling and managing STIs as a strategy for preventing HIV transmission should be a high priority in primary health care facilities, SRH services, private clinics and other health services. Using community-owned resource persons to sensitize community members on PP and RH related issues

12Management Sciences for Health Stronger health systems. Greater health impact. Saving lives and improving the health of the world’s poorest and most vulnerable people by closing the gap between knowledge and action in public health. Go to the people, live with them, love them, learn from them, start with what they have, build on what they know, but of the best leaders, when their task is accomplished, the work is done, the people will all say, we have done it ourselves. THANK YOU!