1. Rose Wilcher November 19, 2008 Strategic Considerations for Strengthening the Integration of FP and HIV Service Delivery Programs

2. 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

3. A few caveats… Content based on: –Literature review (including Cochrane review) –Expert opinion –Programmatic experiences –Evidence emerging from on-going studies, including FHI’s 5-country assessment A collective product Focus on four models of integration

4. What’s in a name? Strategic considerations vs. –Technical recommendations –Programmatic guidance –Best/Promising practices –Etc

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Cross-cutting technical inputs Policies and guidelines Training Facility staff sensitization Supportive supervision Task-shifting IEC/BCC materials Space Record-keeping/M&E Logistics Referrals Community-based activities Specific intervention activities offered in the following areas:

12. 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

13. 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?

14. Next Steps Toolkit available now “Strategic Considerations” available early 2009 Journal supplement on FP/HIV integration Continue advocacy efforts Develop M&E indicators