Integration of HIV services: Lessons Learned from HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) Itamar Katz PhD, MPhil Abt Associates, Health Systems 20/20, Bethesda, United States Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane Universitys School of Public Health

Background Substantial HIV funding Frequently weak health systems Health workers, systems and structures dedicated solely HIV Rapid scale-up 2

Issues Separation of HIV services from those of sexual and reproductive health, antenatal care and maternal and child health Expensive health information, supply management systems Underutilized health workers 3 Steven John

HAPSAT HAPSAT is an HIV/AIDS Program Sustainability Analysis Tool Provides recommendations on enhancing the sustainability of the HIV responses 4

Questions HAPSAT addresses Sustainability of HIV programs in limited- resource settings: What should be prioritized? How should additional resources be mobilized? What efficiency measures should be applied? 5

Average time for ART and HCT services per patient per year Assumption: additional 40% of patient visit time for time spent beyond face-to-face visit (e.g. record review), based on interviews Source: Wong, Katz et al, 2012

Standard FTE patient load for ART and HCT services ServiceDelivery typeWork day hoursPatient coverage per year ART MD/HO-led with Nurse team 6 hours 1,000 patients (MD/HO and Nurse) *Nurse with leftover time, equal to 371 ART patients 4 hours 667 patients (MD/HO and Nurse) *Nurse with leftover time, equal to 371 ART patients Nurse-led 6 hours 623 patients (Nurse) 4 hours 416 patients (Nurse) HCT Seen by one HW 6 hours 3,408 patients 4 hours 2,272 patients Calculate labor imbalances by comparing table with actual FTE patient loads Source: Wong, Katz et al, 2012

Governance Integration should be considered where efficiency gains can be achieved, as long as the quality of services maintained or improved Frequently dependent on the governance of the programs Steven John

Integration of social services Much of behavioral prevention and support for PLHIV and OVC through donor-funded NGOs In Guyana, several NGOs have had to cease providing HIV services 9

Sustaining NGOs HIV interventions Government funding of NGOs Innovative funding mechanisms (fundraising, sponsorships, becoming for-profit) Integration into public social services: Integrate NGO work Might not reach marginal populations Integrate into curriculums: work safety, teachers, health workers, etc. 10

Lessons learned Integration should be promoted where efficiency gains can be achieved, as long as the quality of services maintained or improved Integration should be applied on both medical and social HIV services 11

12 Visit: Country reports, the tool and document on target setting Thank you For more information…