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 Rhetoric to Reality: Delivering Integrated HIV and Family Planning Services (PAI, FHI 360, EngenderHealth, JSI) 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 Rhetoric 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 HIV prevalence per province Kenya 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 Screening Family 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 point Progress 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 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 STIs n= 2,335 FSWs Screened for Cervical Cancer n= 2,144 FSWs HIV Positive n= 949 (3%) HIV Positive n= 949 (3%) Positive for unmet needs n= 840(5.5%) Positive for unmet needs n= 840(5.5%) STI Positive n= 134 (6%) STI Positive n= 134 (6%) Positive for cervical cancer n= 88 (4%) Positive for cervical cancer n= 88 (4%) HIV Positive linked to care = 759 (80%) HIV Positive linked to care = 759 (80%) Linked to FP services: =429(51%) Linked to FP services: =429(51%) Provided STI treatment: =134(100%) Provided STI treatment: =134(100%) Ca Cx Positive linked to care: = 67 (76%) 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 integration National 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 Kenya