Integrating STI/HIV management strategies into existing MCH/FP programs: Lessons from case studies in East and Southern Africa

Sub-Saharan Africa is confronting an HIV/AIDS epidemic and virtually all health programs in the region are seeking ways of preventing and reducing the spread of this virus. To compound the problem, the presence of certain sexually transmitted infections (STIs) is known to increase risk of the sexual transmission of HIV. The sub-Saharan region is believed to have some of the highest levels of STIs in the world, thus controlling STIs is not only an important reproductive health care strategy in itself but also a key strategy in reducing the spread of HIV. The strongest evidence to support this has come from the Mwanza Intervention Trial in Tanzania, which demonstrated that improved early detection and treatment of STIs can significantly reduce the incidence of HIV. Putting these principles into practice through health care programs in sub-Saharan Africa remains a challenge. This paper describes the results of a few, selected case studies of efforts that have already been made to address this challenge in east and southern Africa. The case studies document the application of these principles in the context of female clients attending MCH/FP clinics

Integration of STI and HIV/AIDS with MCH-FP services: A case study of the Busoga Diocese Family Life Education Program, Uganda

The Family Life Education Project (FLEP) was started in 1986 by the Busoga Diocese of the Anglican Church of Uganda with assistance from Pathfinder International. The project provides integrated MCH, FP, STD, and HIV/AIDS services to more than 500,000 individuals through 48 clinics and 162 trained village health workers (VHWs). Each clinic serves an estimated 11,000 people living in a sub-Parish. Each sub-Parish has a health subcommittee selected by the community that is responsible for hiring clinic staff, identifying VHWs, and mobilizing resources for clinic staff salaries. Data suggest that the program is reaching a large number of clients through the clinic and community-based approaches. The methodology used for the case study involved review of available data and reports, in-depth interviews with management team, modified situation analysis, and guided group discussions. As noted in this report, using simple rural-based health facilities and volunteer community-based workers to provide family planning and STD/HIV services using the integrated approach is possible, however considerable work must be done before the project can provide high-quality MCH/FP and STD/HIV services to every client using this approach

Integration of STI and HIV/AIDS services with MCH/FP services: A case study of the Mkomani Clinic Society in Mombasa, Kenya

Most national MCH-FP programs in sub-Saharan Africa are shifting their programmatic strategies toward a broader reproductive health service approach that includes integrating STI and HIV/AIDS services into existing MCH-FP programs. This is based on the belief that integration will lead to more cost-effective and better-quality service, and maximize use of existing resources. There is an assumption that the basic infrastructure for the MCH-FP programs can absorb the extra demands of the STI/HIV/AIDS services with minimal additional inputs and that staff providing MCH-FP services require only minimal training to be able to provide STI/HIV/AIDS services. There is a further assumption that the addition of STI/HIV/AIDS services to existing MCH-FP services may reduce the stigma associated with providing STIs and HIV/AIDS services in isolation. The Population Council, through the Africa OR/TA Project II, is carrying out a number of case studies of projects and programs that have initiated integrated services with MCH-FP services. This report describes a case study of the integration activities being undertaken by the Mkomani Clinic Society in Mombasa, Kenya

Dual protection in sexually active women.

OBJECTIVE: To determine the prevalence and co-factors associated with the practice of dual protection against sexually transmitted infections (STIs) and unwanted pregnancy in a cross-sectional sample of South African women. DESIGN: Secondary analysis of cross-sectional household survey data. METHODS: Statistical analysis of responses by sexually active women to the question, 'Was a condom used on the last occasion you had sex?' were obtained from the women's questionnaire of the South African Demographic and Health Survey in relation to a number of other variables. RESULTS: (i) 10.5% of all sexually active women aged 15-49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (ii) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (iii) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (iv) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (v) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms. CONCLUSIONS: There is an urgent need for targeted programmes that increase dual protection with condoms

Integration of STI and HIV/AIDS with MCH-FP Services: A case study of the Nakuru Municipal Council\u27s project on strengthening STD/AIDS control

Kenya’s Nakuru Municipal Council (NMC) operates five clinics located primarily in residential areas with high concentrations of people. The clinics provide basic antenatal, child welfare, STI, and other curative services, and family planning services are available at four of the clinics. One provincial referral hospital operated by the Ministry of Health also provides MCH-FP and HIV/STI services in a special STI treatment clinic. The seven public health facilities in Nakuru Municipality are participating in a collaborative project with the Department of Community Health at the University of Nairobi, the University of Manitoba in Canada, and the Nairobi Municipal City Council. The goal is to reduce the incidence of STD\u27s, including HIV/AIDS in Kenya, through strengthening management of STDs and AIDS at the health facilities and establishing sustainable community-based STD/AIDS control activities with an emphasis on women\u27s participation. This report describes a case study of the integration activities being undertaken by the NMC. NMC clinics have adequate basic infrastructure to provide MCH-FP and STI/HlV/AlDS services using an integrated approach, however they lack basic equipment and supplies to support the integration of these services

An assessment of the Zimbabwe National Family Planning Council\u27s community based distribution programme

Since its inception, the Zimbabwe National Family Planning Council’s (ZNFPC) community-based distribution (CBD) program has made significant and well-documented contributions to the demand for and use of family planning in Zimbabwe. Data from several studies have shown, however, a steady decline in this contribution and that the CBD agents spend more time resupplying existing clients than recruiting new acceptors. Moreover, the CBD program urgently needs to be able to address the AIDS crisis in the country. ZNFPC has undertaken this review to guide it in making appropriate decisions about the future direction of the program, allowing CBDs to have a broader range of responsibilities and modifying the structure to become more efficient. Some activities felt to be acceptable and feasible include: providing more detailed information on STIs/HIV/AIDS; identifying and referring individuals with STI symptoms for diagnosis and treatment at clinics; providing supportive counseling to people living with HIV/AIDS; educating communities about HIV voluntary counseling and testing (VCT) services and motivating their use; providing ongoing supportive counseling after HIV VCT testing; assisting parents to better communicate with their children on sexual and reproductive health issues; and advising adolescents like surrogate aunts and uncles

A situation analysis of the maternal and child health/family planning (MCH/FP) program in Botswana

Botswana has a rapid annual population growth rate and a high total fertility rate. It also has one of the highest levels of contraceptive use in sub-Saharan Africa. Infant and under-5 mortality rates have fallen, yet maternal mortality remains high. The Government of Botswana has developed an extensive network of health care facilities that provide services through an integrated approach. Family planning (FP) services are available at all three levels of the MOH system (hospitals, clinics, health posts). Services for managing sexually transmitted diseases (STDS) have recently undergone a substantial change with the introduction of the Syndromic Approach to STD management. There is concern about a rapid increase in the number of persons infected with HIV. Although the Government of Botswana continues to make efforts to meet the need for FP, STD, and AIDS services, there remains a large unmet need. The Botswana Population Assistance Project is USAID’s approach to strengthening MCH/FP and STD/AIDS services to improve quality and availability of FP/STD services and expand AIDS prevention measures

Using a rapid assessment approach to evaluate the quality of care in an integrated program: The experience of the Family Health Division, Ministry of Health, Botswana

To strengthen existing efforts by the Government of Botswana in responding to the HIV/AIDS epidemic, USAID provided financial and technical assistance through the Botswana Population Assistance (BOTSPA) project. BOTSPA’s goal was to improve the quality and availability of family planning (FP) and sexually transmitted infection (STI) services through designing, implementing, and monitoring activities that would lead to the eventual institutionalization and sustainability of high-quality FP and STI/HIV/AIDS services. The Ministry of Health requested assistance from the Africa OR/TA Project II to develop and test an approach for routinely measuring the quality of service delivery and assessing skills retention by staff trained through in-service courses. A rapid assessment mechanism was designed and then used to determine the readiness of health facilities in Botswana to offer quality FP and STI management services. According to this report, the mechanism was found generally acceptable, easy to use by staff and managers, and provided valid information on the readiness of the health facilities to provide FP and STI services