1. From Evidence to Programming: GBV in the HIV and AIDS response Maureen Obbayi; Nduku Kilonzo PhD; Lina Digolo MbChB; Lilian Otiso MbChB The LVCT GBV/PRC team; The Division of Reproductive Health/Ministry of Public Health and Sanitation Trocaire; The Elton John AIDS Foundation; PEPFAR/USAID 1

2.  40M people  Constitution: right to health, RH  7.1% HIV prevalence (15-64)  Mixed HIV epidemic: general, geographic, concentrated; Gender & age disparities  Sexual violence: limited data; high prevalence - 1 in 5 women experience sexual violence (SV) 2

3. LVCT - inputs 3 Scale up Health & Community systems Technical support to Govt. Research/ Piloting Coverage - access, equity (in both delivery and uptake); Strengthened health systems; New knowledge; Quality HIV testing and counselling Linking testing to care, prevention, SRH Serving vulnerable/at risk populations: MSM Youth PWDs Survivors of SV - Innovation - New service delivery models Policy reforms action: - National strategies - Standards & indicators - Policy implementation - LVCT Training Institute - Quality assurance of services - Programme data utilization - CSO coordination frameworks - TIMISHA (LVCT South to south capacity building model) - Direct service delivery - Demand creation & advocacy n indigenous Kenyan NGO, country led, managed, country priorities LVCT: an indigenous Kenyan NGO, country led, country managed, country priorities

4. ACTION: HIV, SRH, mental Justice outcomes Evidence to ACT: -Research -Piloting LVCT’s GBV/ PRC action framework Platforms to ACT: -Policy reforms -Systems strengthening -Partnerships Impetus to ACT: -Quality service delivery -Client feedback

5. Survivors of sexual violence? – VCT counsellors from Quality Assurance – Emerging PEP data Operational research study (2004-6) – Diagnosis: perceptions, priorities for service delivery – Intervention: standard of care, health provider training – Evaluation: uptake and delivery of care (prophylaxis, examination, counselling) Kilonzo et al, 2007; 2008; 2009 5 2003/4: HIV and SV?

6. 6 Diagnosis No regulatory framework, standards or reporting Inconsistent service delivery, limited capacities Perceptions: “Lets say I have a boyfriend and am against the act, but you can be forced. He will come at night when he knows I am there because he want to do …, and to make me to give him. He knows if he rapes me... and when others get to know, they will reject and laugh at me saying I was raped – so I will give in” (adolescent female, 16yrs, Thika)

7. 7Intervention Stakeholder consultations: DRH, local HMTs Standard of care: algorithm, protocols, procedures Provider training Community mobilization CASUALTY/OPD Emergency management PEP/EC, examination, PRC1 form STI drugs Counseling - Trauma/crisis, HIV test, PEP adherence; preparation for Justice system Laboratory HIV care: PEP management: Laboratory monitoring PEP outcomes on-going follow up 4/52

8. Evaluation in 2006 (n=386; >30% data rejected) Data for programming.. -median age - 16.5; 56% children; 88% female -55% - knew assailant, children more likely (OR 6.2; p=0) -82% EC delivery -16% lost in client flow Changes: -Child friendly services (Speight et al 2006) -EC services at casualty -Social support & counselling -Strengthening referrals

9. from evidence to programming: research-policy-practice 9 2012/14: QA & survivor retention, SRH/HIV outcomes evaluated 2011/11: PRC kit effectiveness evaluated COE1: 2007 /10: Model for chain of evidence tested 2006: Costing of scale up of PRC services PRC 1: 2004 /06 - Service delivery model tested 2006: - guidelines; training curricular; MOH 263 (PRC 1) medico-legal form 2012.. -84 service sites -> 1,000 health providers trained -15,000 survivors seen GAPS -No knowledge of costs of scaling up PRC by DRH -Poor medico-legal linkages -Effectiveness of PRC kit for justice unknown; referrals poor -Poor PEP adherence/ SRH outcomes and retention of survivors in health care 2007: DHR Scale up plan with PRC indicators 2009/10: - guidelines 2 nd edition 2011-13: aim- to strengthen medico-legal framework (SOA)

10. 10 Lessons.. HIV programmes (funds, systems, political focus) an opportunity for GBV with good monitoring in-built Investment in internal and local real capacity for: monitoring, evaluation and research Implementation science located in local systems (e.g. commodities & supplies), structures (e.g. reporting) Health sector growth must be aligned to other sectors (justice, law, order)

11. 11 Some key arguments.. Invest in partnerships – are key for policy reforms action which results in research utilization Resource data is essential to mobilize investment, political attention ‘Evaluation of service delivery’ - works with funding partners PRC costing study – US$ 26 per survivor

12. 12 Thanking all these great individuals…