1. Family Planning/HIV Integration in a Large PEPFAR HIV Program – the ZPCT II Experience Prisca Kasonde MD, MMed, MPH Director Technical Support, ZPCT II/FHI 360 AIDS 2012 - Turning the Tide Together

2. 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

3. ZPCT II Coverage ZPCT II Supported Districts: – 6 provinces – 370 public + 17 private HF

4. 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

5. 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

6. 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) –

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Couple receiving FP counseling