1. From choice, a world of possibilities ART Delivery: Providing ART in Sexual and Reproductive Health Setting A Presentation of the Work of Family Health Option Kenya (FHOK) Dr Hugues LAGO IPPF Africa Region Office Linking SRH and HIV International AIDS Conference 2008 Mexico City, Mexico

2. Outline Current situation in Kenya Family Health Options of Kenya (FHOK) Moving from SRH services to comprehensive HIV and SRH services Project success and main constraints Conclusions

3. Background Kenya in figures (2007) Estimated population: 37million (52% females and 48% males) 10-24 years: ~ 36% of the population Crude birth rate: 39.5/1,000 Life expectancy at birth Women: 50 years Men: 51 years Total fertility rate: 5 Contraceptive prevalence rate: 39.3% Births attended by skilled health personnel: 44%

4. Background Kenya in figures (2007) – cont’d HIV prev. in adults: 5.1% Over 60,000 new infections occur annually 140,000 AIDS related deaths occur annually. People receiving ART: 132,000 Young people aged 15 – 24* Use of condoms Last time they have sexe with casual partner* Sex before age of 15* Women25%14.5% Men47%30.9% (*) 2005 data

5. Background Family Health Option Kenya (FHOK) Registered 1962 Member Association of IPPF 5,000 volunteers 14 branches 9 clinics : Eldoret, Kisumu, Meru, Mombasa, Nairobi (3), Nakuru, Thika Second largest supplier of contraceptives in the country Close collaboration with the Ministry of Health

6. FamilyCare Medical Centres Youth Centres Models of Care Project ITM Project YMEP Project FOYs Project Jua Kali Project FHOK PROJECT LOCATIONS

7. FHOK’s work in Sexual and Reproductive Health Family Care Antenatal care and post natal care STI management Adolescent and Youth Sexual and Reproductive Health Management of unsafe abortion and counselling Community outreach activities

8. FHOK’s work in HIV/AIDS Prevention education VCT PMTCT Condoms distribution PEP Management of OI Working with Sex Workers Male circumcision ART Psychosocial support Nutrition education Adherence counseling Lab tests Home Based Care Community outreach activities

9. FHOK’s work in HIV/AIDS Integrating ART into SRH Limitations of MoH “Comprehensive Care Centres” Motivation of staff to offer new treatment programmes Advocacy to MoH to allow ART into non government facilities Assessment of FHOK capacity IPPF MoH Training of Staff by MoH Accreditation of FHOK sites

10. FHOK’s work in HIV/AIDS Providing ART into SRH Same facilities and same providers Doctor: initial clinical and biological assessment Eligible patients benefit: ART free of charge Follow-up visits Referral system with Provincial General Hospital Nurse: authority to write repeat prescriptions

11. FHOK’s work in HIV/AIDS Providing ART into SRH – cont’d Community volunteers (including HIV infected people) provide: Psychosocial support Nutritional counseling Adherence counseling Prevention strategies for PLWH Assistance to deliver drug at home Assistance to identify and recruit people in need of ART

12. FHOK’s work in HIV/AIDS Services offered in 2007 Clinic Number of clients served from January to December 2007 ART OI treatment PEPVCTPMTCT Lab.HIV Tests Nairobi West 922434770709418 Eldoret2243113,160310127 Nakuru74174122,25746612 Thika5546502,19624196 Total242925278,3831,0891,353

13. FHOK’s work in HIV/AIDS Factors contributing to project success Good working relationship with the MOH Collaboration with others stakeholders in the catchment areas of the clinics The fact that 50% of the CHWs are PLHIV Mapping out of all services in the community Establishing of potential partners Provision of feedback on referrals.

14. FHOK’s work in HIV/AIDS Main constraints Donor constraints Cutback in funding Earmark funds Cash flow vulnerabilty Irregular supply of drugs (ART) Lack of resources for beneficiairies

15. FHOK’s work in HIV/AIDS Lessons learned Providing services for HIV/AIDS at SRH clinics attracts new clients and creates opportunities for promoting SRH to a wider population Involvement and participation of HIV positive CHW in HIV/AIDS projects increases acceptability, buy-in and community participation

16. FHOK’s work in HIV/AIDS Lessons learned – cont’d An effective referral system (with effective feedback mechanism) is essential in the success of ART programs Training of CHWs in integrated SRH/HIV service delivery improves their ability to address the needs of PLHIV. A strong public-private partnership is essential in scaling up of ART services: i.e consistent supply of commodities to FHOK by the MOH.

17. Conclusion Providing ART (like other HIV interventions) within SRH setting is plausible, possible and practical The success of this project demonstrate that integration works – we can now use this experience for scaling-up similar programmes. Importance of strengthened M&E systems to be able to document the process and collect results.

18. Acknowledgements Kevin Osborne, Alejandra Trossero (IPPF) Lawrence Oteba, Esther Muketo and the staff and Management of FHOK