Rose Wilcher

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Strategic Considerations for Strengthening the
Integration of FP and HIV Service Delivery
Programs

• Rose Wilcher
• November 19, 2008

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Purpose

• Respond to an immediate need in the field for
  programmatic guidance on how to integrate FP and
  HIV services
• Provide practical technical recommendations to
  inform field-based integration efforts based on
  best available evidence and experience to date

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A few caveats

• Content based on
• Literature review (including Cochrane review)
• Expert opinion
• Programmatic experiences
• Evidence emerging from on-going studies,
  including FHIs 5-country assessment
• A collective product
• Focus on four models of integration

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Whats in a name?

• Strategic considerations vs.
• Technical recommendations
• Programmatic guidance
• Best/Promising practices
• Etc

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Framework

• Background and overarching considerations
• Models of FP/HIV integration
• Benefits and challenges
• Levels of integration
• Cross-cutting technical inputs
• Research needs
• Key resources

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FP into HIV counseling and testing

• Benefits
• High volume of clients
• Reaches men, youth, couples, unmarried women
• Various models of service delivery (mobile,
  home-based)
• Challenges
• Typically no repeat visits
• Reliance on weak referral systems for
  re-supply/follow-up
• HIV clients may not be ready for FP messages
• Feasibility of FP integration into PITC unknown

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FP into PMTCT

• Benefits
• Reaches women of repro age and known HIV status
• High unmet need among postpartum women
• Multiple provider contacts
• Emphasis on facility-based deliveries
• Challenges
• Most PMTCT clients reached during ANC
• Difficulties reaching women postpartum and beyond

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FP into HIV care and treatment

• Benefits
• Reaches only HIV clients
• Regular repeat visits
• May be less stigmatizing environment for HIV
  clients to discuss FP issues
• Challenges
• Unmet need may be lower
• Overburdened providers

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HIV services into FP

• Benefits
• Reaches sexually active population with HIV
  services
• May increase uptake of HIV prevention services
• May increase dual protection
• Can tailor contraceptive counseling based on HIV
  status
• Challenges
• May not reach those at high risk of HIV infection
• Does not easily reach male partners

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Levels of integration

• No one size fits all approach
• Gold standard vs. minimum level of integration
• Numerous considerations
• Resources
• Staff capacity
• Facility set-up
• Epidemiological context
• Existing infrastructure

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Cross-cutting technical inputs
Specific intervention activities offered in the
following areas

• Policies and guidelines
• Training
• Facility staff sensitization
• Supportive supervision
• Task-shifting
• IEC/BCC materials

• Space
• Record-keeping/ME
• Logistics
• Referrals
• Community-based activities

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Research needs

• Well-implemented programs with clear objectives
  that can be evaluated rigorously
• Appropriate indicators attached to integration
  programs
• Strong evaluation designs and systematic OR
  studies that assess impact on FP and HIV behaviors

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Research needs

• Key questions
• Does integrating FP and PMTCT, HIV counseling and
  testing, and HIV care and treatment services
  result in improved health outcomes compared to
  implementing these services separately?
• Are the incremental costs of linking services
  equal or less than the cost of providing services
  individually?

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Next Steps

• Toolkit available now
• Strategic Considerations available early 2009
• Journal supplement on FP/HIV integration
• Continue advocacy efforts
• Develop ME indicators