Family Planning/HIV Integration in a Large PEPFAR HIV Program – the ZPCT II Experience

Prisca Kasonde MD, MMed, MPHDirector Technical Support, ZPCT II/FHI 360

AIDS 2012 - Turning the Tide Together

ZPCT II Background

• Five-year contract funded by PEPFAR through USAID(June 09 – May 14); FHI 360 is the prime partner

• Supports the Ministry of Health to strengthen and expand HIV related services in five provinces

• Objectives include:– Expand and scale up HIV services (CT, PMTCT, ART, MC, Lab & Pharm)– Collaboration with other partners in providing comprehensive HIV

services– Capacity building of MOH– Private-public partnership– Integration at all levels

ZPCT II Coverage

• ZPCT II Supported Districts:– 6 provinces– 370 public + 17 private HF

Rationale for FP/HIV Integration

• High fertility (6.2), high unmet need for FP (27%), high HIV prevalence (14.3%) and high maternal mortality ratio (470/100, 000 live births) in Zambia

• FP is important to PMTCT and reducing the incidence of paediatric HIV

• HIV services provide an opportunity to reach people living with HIV with FP information and services

• Family planning services also provide an opportunity to increase access to HIV CT and other HIV services

Rationale for FP/HIV Integration

• Maximizing the limited HR• Reducing the unmet need for FP is a key objective of the

Zambian national PMTCT guidelines. • Integrated services supported by donors, including PEPFAR

International statements supporting FP and HIV/AIDS linkages

• ICPD program of action (UN 1994) • Family planning and HIV/AIDS in women and children (UNFPA,

WHO 2004) – • Intensifying HIV prevention (UNAIDS 2005)• Declaration of commitment to HIV/AIDS (UNGASS 2006)• Maputo plan of action (African Union 2006) –

The ZPCT II Approach to Integration

• Based on overall systems strengthening• Capacity building of HCWs in government health facilities

– FP module part of PMTCT training; orientation done for CT and ART providers– Additionally, some HCWs trained in FP using full package– FP providers trained as HIV counselors– On site hands-on mentorship

• Support service provision– FP counseling part of routine ANC/PMTCT services with provision of chosen

method if desired – FP counseling part of routine CT and ART services with referrals to on-site FP

provider if method desired– CT corners created within FP service areas and provider-initiated testing and

counseling (PITC) initiated within FP

The ZPCT II Approach to Integration (2)

• Task shifting– Use of lay counselors for HIV CT– Lay counselors also provide group education on FP in ANC and PNC

• Ensuring quality of services– On site hands on mentorship– FP included in QA/QI tools

• Monitoring and evaluation– Routine monitoring of FP related indicators on a monthly basis and tailoring

technical assistance to any gaps identified

• Community mobilization– FP messages are part of community mobilization efforts aimed at raising

awareness of HIV prevention

Impact of FP/HIV Integration in ZPCT II Supported Facilities

• Increase in the number of CT and ART clients referred to FP • Table shows numbers 18 months before and after integration

75 0

2571

329

0

500

1000

1500

2000

2500

3000

CT ART

Clients Referred to FP

Before After

Impact of FP/HIV Integration in ZPCT II Supported Facilities (2)

• Increase in the number FP clients receiving CT services • Table shows numbers 18 months before and after integration

Summary

• ZPCT II highlights the feasibility of using a referral-based model to make FP a routine part of HIV care

• FP/HIV integration possible by incorporating FP into core systems strengthening interventions

• More can be done, including tracking and ensuring that referred clients actually receive desired method

• Task shifting necessary in resource limited settings• Collaboration and leveraging different partner resources

needs to be strengthened

Lessons for Other PEPFAR Programs

• HIV programs can be a platform to provide more holistic, integrated care to women and families affected by HIV

• HIV and FP implementing partners can leverage each other to support integration (e.g. training and commodity supplies)

• Global support for integration = opportunity to accelerate progress toward HIV goals, better maternal and infant health outcomes, and greater realization of women’s rights

Couple receiving FP counseling