Update SRH/HIV Linkages Research Agenda from January 2013 to January 2015

Update SRH/HIV linkages research agenda from January 2013 to January 2015

Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 1. MOHCC/NAC World Bank/ (co-PIs: Zimbabwe HIV/SRH (includes 9 Rando Intended outcomes: to measure whether changes in the level Enias Baganizi (WB) and Simukai core services- ANC, m of integration over time brings about changes in unit costs of Zizhou (MOHCC) ART, FP, CCS, VMMC, promo more integrated services. Key variables are national HTC, CPD, GBV, and tion integration program dose at the district and facility level, level PMTCT) and of integration, unit costs of services, local demographics and Differ demand for services ence- in- differe nce quasi- experi menta l design 2. Alliance/ KANCO Kenya SRH/HIV Qualit Findings presented at ICASA ative Study, syste matic literat ure revie w 3. In collaboration with IPPF, involvement Botswana SRH/HIV Qualit  CSO Involvement in the Linkages Project of civic society organisation (CSO) on Malawi ative  CSO partnership: Successes, challenges, lessons & SRH/HIV linkages Swaziland opportunities of linkages project - Perceived roles and involvement of CSOs on scale-up on SRH/HIV linkages Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 4. SRH/HIV linkages: Client satisfaction Botswana SRH/HIV Quanti  Clients’ perceptions, experiences including waiting time study Namibia tative and expectations of outpatient services received from the Zimbabwe selected facilities  Client’s feedback to establish whether standards of care were followed.

 Client’s care issues of concern and opportunities for individual and system quality improvement.

 Perceptions of service providers on SRH/HIV integration.

5. SRH/HIV linkages: End Evaluation All 7 countries SRH/HIV Mixed  Relevance of SRH/HIV linkages to country needs, metho priorities and changing context d,  Effectiveness of SRH/HIV linkages project in achieving Quanti linkages at policy, systems and service delivery level tative /Quali  Efficiency of the SRH/HIV linkages project tative  Sustainability of SRH/HIV linkages and its benefits beyond the tenure of the project Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 6. WHO Steering Group (WHO, WHO HQ Geneva SRHR of women living Syste Guidance on SRHR of women living with HIV UNFPA,UNAIDS) & WHO Guideline with HIV mic Development Group (GNP+, ICW etc.) revie ws will be undert aken for those areas for which eviden ce has not alread y been revie wed 7. l’Institut de santé publique, West Africa (2015 Integration of SRHR Opera Guidance on delivering integrated SRH services to women épidémiologique et développement de Cote d’Ivoire; Burkina interventions in tional living with HIV l’Université de Bordeaux; National Faso and Togo; 2016 clinics to benefit resear Institute of Health Nigeria and Senegal) women living with ch HIV Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 8. HIV counseling and A Unintended outcome/new method: Kenya, Swaziland testing into FP model quasi- Programme Science/embedded research approach meant experi intervention and comparison design rendered obsolete for Integra Initiative (and Malawi) 1 and PNC model 2 in Population Council, Co-PI Charlotte public facilities menta analysis – Integra Index of Integration developed to measure Warren and model 3 general l study degree of clinic integration over time. Two dimensions: LSHTM PI Susannah Mayhew and Co-PI SRH services (IPPF condu structural (physical and human resources integration) and Anna Vassall clinics) cted in functional (delivery of integrated care). IPPF Jon Hopkins 42 Impact of integration: faciliti Where functional integration was achieved we found es in statistically significant improved: HIV testing rates; Reported Kenya consistent condom use; Technical quality of care of integrated and HIV/FP and HIV/PNC services. Swazil WLHIV reported more unintended pregnancy, but and significantly more likely to use dual methods. ‘Unmet need’ Measu targets need to incorporate the concept of ‘inappropriately ring met need’ and WLHIV need better access to LARCs. the Integration does not necessarily reduce stigma. Many PLWHA benefi preferred to use stand-alone specialist HIV facilities where ts and they did not fear disclosure at the facility itself and also gained costs support from other PLWHA. However most facilities and staff of seem not to generate stigma – the challenge is women’s delive perception that they will be stigmatized at facilities. ring HIV/ SRH integration most influential on work-load for integr provider initiated CT, PNC & STI services ated Increased staffing for HIV-related services, may have come at HIV the cost of reductions of staff available for other services such and as PNC, and lead to greater imbalances in staff workload SRH Policy makers should also be careful about overworking staff servic and assess integration in the broader context of HR planning es to and training. reduc Process findings: Staff in facilities with high functioning e HIV integration scores showed better ability to cope with infecti workload and other pressures; Improved teamwork and on provider motivation are key to this - if they feel supported by (and managers associ Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 9. Population Council (Link Up) Myanmar Young MSM sexual Data - MSM self-efficacy to use condoms, get tested for HIV health and HIV collect - Actual condom use, uptake of testing ion - Improved quality of facility service delivery among MSM - B as el in e / E n dl in e cr os s- se ct io n al s u rv e ys of al l w o m e Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 10. Population Council (Link Up) Uganda Young PLHIV sexual Data - Self-efficacy to use condoms, other contraception and reproductive collect - Uptake of HIV testing health ion - Need for family planning (females only) among - Improved quality of facility service delivery YPLHI V - L o n gi tu di n al st u d y of Y P L H IV w h o re ce iv e Li n k U Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 11. International HIV and AIDS Alliance Myanmar and Uganda SRHR and HIV Mid Documentation and lessons learned from Link Up in 5 (Link Up) linkages for young Term countries, as well as more specific results from 2 country in- key populations Revie depth evaluation w (unde rway) Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 12. FHI 360 Zambia SRH/HIV/Youth - Cr - Many ALHIV had unprotected sex and those who used PI: Donna McCarraher os contraception relied on male condoms only. s- - Very few ALHIV reported accessing family planning se services cti - Nearly all ALHIV wanted to have children in the future and on want more information about planning for pregnancy al - Forced sex was common among ALHIV qu - Nearly 60% of ALHIV had not disclosed their HIV status ali because of fear of stigma tat - Alcohol use was related to ART adherence ive - Adolescents who lived in homes where their HIV status an was known were more likely to report better adherence d qu an tit ati ve int er vie ws wi th ad ol es ce nt s liv in g wi th HI Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 13. Population Council (Link Up) Bangladesh Young brothel-based Data - Self-efficacy to use condoms, other contraception, get PI Eileen Yam FSW HIV and SRH collect tested ion - Uptake of HIV testing among - Need for family planning (females only) FSW - Improved quality of facility service delivery - Ba sel ine /E nd lin e cr os s- sec tio nal su rv ey s of all wo me n livi ng in fo ur int er ve nti Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 14. Population Council (Link Up) Ethiopia Pregnancy among Intervi Descriptions of the following: PI Eileen Yam FSWs ews of - Circumstances under which FSWs become pregnant. FSWs - Pregnancy outcomes and maternal health behaviors. - In- - Availability of, and perceived need for, HIV and SRH depth services. intervi ews with 20-30 FSWs ages 18+ who have ever been pregn ant.

Servic e provid er intervi ews - 10 in- depth intervi ews among key infor mants knowl edgea Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 15. Respond Project Tanzania FP/HIV, FP/RMNCH Pre- Objectives: EngenderHealth PI Ghazaleh post Samandari. Population Council PI design 1. To assess the extent to which different models of Francis Obare witho integrated service provision increase the range, uptake ut and quality of selected RMNCH/HIV services, and lead to a contro greater diversity in the profile of clients. l group 2. To measure the effect of integration on provider skills, client access to and satisfaction with services and provider/client attitudes towards provision of integrated services.

To assess the efficiency of delivering integrated services in terms of: cost, utilization of existing infrastructure and human resources. 16. FHI 360 & UNDP 3 countries in LAC GBV/HIV Partici - Identify risk and protective factors associated with key (focus on key patory populations’ exposure to violence and HIV populations, , - Identify approaches to policy and programming that better especially MSM and format respond to and mitigate their risk of violence and HIV transgender women) ive qualit ative intervi ews and FGDs with key popul ations Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 17. FHI 360 Uganda Community-based Cluste - CHWs demonstrated knowledge of counselling messages PI: Aurelie Brunie FP/HIV integration r and safe testing rando - Most FP clients accepted an HIV test from a CHW during mized the intervention contro - CHWs reached new FP clients who came in for HIV services lled trial; - No adverse effect observed on the quality of FP services, or cross- on CHWs’ perceptions of their ability to manage their sectio workload nal survey with comm unity health worke rs (CHW s) offerin g integr ated servic es and with clients in the interv ention and contro l arm Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 18. UCSF Kenya FP/HIV service 1. Pr Development and dissemination of a process evaluation of KEMRI integration oc FP/HIV service integration including the FP/HIV integration PI: Craig Cohen (UCSF) es cluster-RCT, and subsequently by the Kenyan MOH with s Co-PI: Maricianah Onono (KEMRI) support from Family AIDS Care & Education Services (FACES) ev al Development of an “integration” toolkit for use by clinic in- ua charges. The toolkit will be beta-tested in Kenya, with tio dissemination through the Kenyan MOH. n Took- kit develo pment and beta- testin g Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 19. Population Council (Evidence Project ) 2 sub counties in Integration of FP into Pre – Intended USAID/PEPFAR Busia County, Kenya HIV services at post - Increased proportion of WLHIV using highly effective PI Charlotte Warren CoPI Wilson community level quasi contraceptive methods; Liambila experi - Increased proportion of WLHIV who use “dual menta method” contraception l - Facilitating factors identified and challenges are design addressed in delivering integrated FP/HIV services : (IR) Interv ention CHVs provid ing HIV servic es, traine d in couns eling, provis ion of FP metho ds (cond om, Pills, EC and SDM) and referr al for LARC- PM. Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 20. FHI 360 & EGPAF Uganda FP/HIV/gender Evalua - Care & Treatment clients reporting exposure to FP PI: Theresa Hoke tion of counseling increased in intervention sites; however, use of clinic- condoms and other contraceptives remained low among based these sexually active clients FP/HI - Couples counseling for Care & Treatment clients increased V - Participation in health services increased among men integr exposed to the male engagement intervention ation interv - Men reporting any condom use increased ention - FP service delivery to Care & Treatment clients could be with a more systematic and complete. comm - Evidence of harmful gender norms that could interfere with unity- use of health services and FP uptake based male engag ement compo nent Pre- and post- interv ention cross sectio nal intervi ews were condu cted with HIV Care & Treat Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 21. FHI 360 Bangladesh FP/HIV (key - - Unmet need for contraception was 25% among hotel- PI: Karen Katz populations – FSWs Fo based FSWs, 36% among street-based FSWs, and 58% of and women who r female IDUs inject drugs) m - While condom use was reported to be high, use was at inconsistent because many clients did not want to use iv condoms, FSWs could earn more money if they agreed not e to use them, and condom breaks were common as - Reports of sexual and physical violence were high se ss - These groups would benefit from increased access to FP m information and services. Drop-in centers are the preferred en site for receiving FP services t in cl u di ng su rv ey s an d in - de pt h in te rv ie w s wi Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 22. FHI 360 Kenya FP/HIV (key Phase Formative Results: PI: Lisa Dulli populations – female I: - Infrastructure, client-provider interaction, and couple sex workers) Forma dynamics top three barriers preventing FSWs from tive, obtaining contraceptives cross- - Drop-in centers most preferred model of service delivery sectio for FSWs; strongly supported the provision of FP from nal peer educators study using - Evaluation Results: qualit - Intervention increased modern FP method use, but not ative dual method use, largely due to significant decrease in metho condom use among women who did not have a non-paying ds partner at baseline and gained such a partner by endline (FGDs (women used condoms with paying partners, but usually ) did not with non-paying partners). This decrease in Phase condom use was seen in both intervention and II: comparison groups, but greater in the intervention group. Two group (inter ventio n/com pariso n), quasi- experi menta l pre/p ost- test evalua tion. 640 FSW (320 Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 23. FHI 360 South Africa, Uganda HC/ART interactions Non- - Ovulation and pregnancy rates were similar between the PI: Kavita Nanda rando two groups, suggesting that ART containing nevirapine mized has no notable effect on contraceptive effectiveness clinica l trial; 196 wome n taking COCs and ART contai ning nevira pine compa red to 207 wome n taking COCs but ineligi ble for ART Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 24. ECHO Trial – FHI 360, WHO, South Africa, Zambia, HC/HIV Rando - HIV acquisition is primary outcome University of Washington, WRHI. Swaziland, Kenya mized - Unintended pregnancy and method discontinuation are trial of secondary outcomes three contra ceptiv es (DMP A, Jadelle , Coppe r IUD) Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 25. UCSF and Kenya Medical Research Kenya HC/ART interactions Retros - Pregnancy incidence stratified by EFV vs. NVP use among Institute pectiv women using contraceptive implant vs. DMPA, COC and PI: Craig Cohen e other forms of more effective contraception Co-PI: Rena Patel cohort study of ~95,0 00 wome n- years using ART, and variou s forms of contra ceptio n follow ed in the Family AIDS Care & Educa tion Servic es (FACE S) progra m in weste Organization / PI Country / Location Linkages Theme: Rese Intended / Actual Outcomes / Key Variables HIV/ SRH, Youth, arch FP, STI, MNCH, Desig GBV, HC n 26. Botswana Cost-efficiency study On Namibia conce ptuali sation