How HIV/AIDS scale-up has impacted on non- HIV priority services in Zambia? Joseph Simbaya Aisling Walsh Phillimon Ndubani Pat Dicker Ruairi Brugha

Zambia background HIV 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

Methods Review of 39 health facility client record trends from 3 districts covering 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.

ART Coverage 2004 to 2007 YearNNumeratorDenominatorCoverage % % % %

Trends in infant vaccination and ART,

Reproductive health service coverage

Intrafacility correlations between HIV and non-HIV services, (rank correlations > 0.3 highlighted). Facilities reporting Clients for two services Number of facilities Spearman Rank Correlation (positive unless otherwise stated) ART and Antenatal Clinic ART and Family Planning Clinic ART and DPT 3 vaccine ART and BCG vaccine PMTCT and Antenatal Clinic PMTCT and Family Planning Clinic PMTCT and DPT 3 vaccine PMTCT and BCG vaccine VCT and Antenatal Clinic VCT and Family Planning Clinic VCT and DPT 3 vaccine VCT and BCG vaccine

Correlation in ART and Family Planning service trends,

Correlation in VCT and Family Planning client trends,

Conclusions Positive 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 Institutions Funders Open Society Institute DANIDA Irish Aid Implementing Institutions Frontiers Development and Research Group Institute of Economic and Social Research, University of Zambia Collaborating Institutions Royal College of Surgeons in Ireland London School of Hygiene and Tropical Medicine