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

2. 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

3. Study Objective Assess the effect of HIV/AIDS scale-up on non-HIV service delivery and coverage

4. Methods Review of 39 health facility client record trends from 3 districts covering 2004-07 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.

5. Scale-up in ART, VCT, PMTCT client nos.

6. ART Coverage 2004 to 2007 YearNNumeratorDenominatorCoverage 200416501824861 20.2% 2005161311326657 49.2% 2006162194728551 76.9% 2007162281130433 75.0%

7. Trends in infant vaccination and ART, 2004-07

8. Reproductive health service coverage

9. Intrafacility correlations between HIV and non-HIV services, 2005-07 (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 90.22 ART and Family Planning Clinic 90.83 ART and DPT 3 vaccine 90.00 ART and BCG vaccine 90.27 PMTCT and Antenatal Clinic120.50 PMTCT and Family Planning Clinic120.33 PMTCT and DPT 3 vaccine12- 0.11 PMTCT and BCG vaccine120.14 VCT and Antenatal Clinic110.12 VCT and Family Planning Clinic110.38 VCT and DPT 3 vaccine110.15 VCT and BCG vaccine11- 0.30

10. Correlation in ART and Family Planning service trends, 2005-07

11. Correlation in VCT and Family Planning client trends, 2005-07

12. 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

13. 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