Integrating Family Planning and VCT Services

Clients Seeking HIV-related Services Why Integrate HIV and RH Services Share common needs and concerns: are often both sexually active and fertile are at risk of HIV infection or might be infected need access to contraceptives need to know how HIV affects contraceptive options and Vice Versa Clients Seeking RH Services AND

Role of FP in Preventing infant HIV Infections Support for mother and family Prevention of trans- mission from an HIV- infected woman to her infant Prevention of unintended pregnancies in HIV- infected women Prevention of HIV in women, especially young women Source: WHO, Family planning and effective use of contraceptives

Benefits of FP in PMTCT Programs Source: USAID, Benefits of Integrating Family Planning and PMTCT in High HIV Prevalence Countries Annual Projection 155,000 32,000 39,000 55,000 20,000 75,000 71,000

Dual protection Means using a method/methods that protects both against HIV/STIs and Pregnancy This can be achieved in three ways Abstinence Mutual monogamy with uninfected partner and using of a contraceptive method Use of Female or Male Condoms Use of a condom and another more effective contraceptive method-Dual Method Use

BENEFITS FP IN VCT 1) VCT services reach more clients than any other HIV service, thus Family planning in VCT is a way of increasing access to family planning services. Family planning in VCT services can reach clients who do not typically go to family planning services such as men and youth. FP-VCT also prevents unintended pregnancies in HIV+ women and therefore reduces MTCT and number of infants born HIV infected

Enabling Factors Well structured and stable VCT programme Supportive MOH structure [DRH/Nascop Existence of VCT and FP guidelines and a supportive NHSSP11 Existence of and oversight by a technical committee Commitment and team work from the VCT/FP sub-committee Mobilisation of funds for a common goal

Milestones in FP-VCT Integration in Kenya FP-VCT subcommittee FP-VCT int. strategy Training manual Advocacy/ sensitisation Training & supervision M&E Operations research Sustain and scale up Formative assessment ?

FP-VCT integration in Kenya Results of formative assessment in 2003: –Integration is acceptable 89% of clients 100% of service providers and in-charges –Potential FP demand exists »40% of clients not on FP –Wide variation in VCT provider background 61% had clinical background 37% were FP-trained –Level of FP in VCT should be decided facility-by- facility Source: FHI report, 2003

Conclusions based on findings Assessment in Kenya found that integrating FP into VCT services: –Is feasible –Is acceptable –Does not appear to affect HIV service quality –Family planning demand exists

Development Of FP/VCT Integration Strategy 1.Sharing of formative assessment results 2.Formation of FP- VCT Sub- committee 3.Final product DRAFT MINISTRY OF HEALTH NATIONAL AIDS & STD CONTROL PROGRAM (NASCOP) AND DIVISION OF REPRODUCTIVE HEALTH STRATEGY FOR THE INTEGRATION OF HIV VOLUNTARY CONSELLING AND TESTING (VCT) SERVICES AND FAMILY PLANNING SERVICES Task Force Members MOH-NASCOP, MOH-DRH, FHI, CDC, JHPIEGO, KNH, KICOSHEP, AMKENI FHI facilitated the functioning of the Task Force

Levels of Integration Definition: Incorporation of some or all of family planning services in VCT Four levels depending on resources and level of provider training: –Level I: Condoms and pills –Level II: Condoms, pills, and injectables –Level III: Condoms, pills, injectables, and IUCD –Level IV: A full range of contraceptive methods All levels should be able to: –Assess for pregnancy and STI/HIV infection risks –Provide information and counseling on FP methods –Refer clients for services not available

Training Manual Development Tools approved by NASCOP’s VCT main committee in June 2004 Harmonization of the TRAINING Manuals which resulted in a Trainers and Participant manual Ministry of Health – Kenya Family Planning Training for Voluntary Counselling and Testing Providers: An Integrated Approach to Counselling and Service Provision Trainer’s Manual Kenya National Training Manual for Integrating FP into VCT, December 2006

Ingredients for FP/VCT Integration Advocacy and sensitisation at all levels of the health care system Pre-training site selection to diagnose whether the site will benefit from integrated services Training of TOTs and service providers Provider tools Regular Support supervision Client education materials for demand creation M&E / Operations research-monitor VCT quality and FP method provision

FP-VCT integration in Kenya (con’t) Results of operations research in 2006: –Trained VCT providers nearly twice as likely to discuss a client’s desire for more children (11% to 20%) –Providers only slightly more likely to discuss clients’ current FP use (23% to 28%) –Providers more likely to discuss FP methods with clients (46% to 63%) –Small effect on clients’ reports of contraceptive uptake (17% to 29%) Condoms only method provided Source: FHI report, 2006

Results of operations research in 2006 [contd] –27% - 29% of VCT clients at risk of unintended pregnancy –No change in VCT session time or counseling content –Provider, in-charges, and clients said FP in VCT improved VCT quality Source: FHI report, 2006

Recommendations Improve provider skills in pregnancy risk screening Train more VCT providers per centre to increase access Continue monitoring of VCT quality and FP method choice provision

Sustaining and Scaling up FP in VCT Continuous advocacy Training of service providers Diversification of funding sources Mobilization of available resources Institutionalization supervision Utilization of already developed Human resource, tools and materials Adoption of the OJT model of training