AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #253 - Thinking out of the box: A novel model for delivering integrated HIV and reproductive health services in eThekwini District, KwaZulu-Natal, South Africa
Authors: Presenting Author: Prof Jennifer Smit - MatCH
Additional Authors: Ms. Cecilia Milford, Dr. Mags Beksinska, Ms. Zonke Mabude, Ms. Claudia Ngoloyi, Ms. Melanie Drace, Dr. Fiona Scorgie, Miss. Letitia Rambally, Miss. Jacqueline Pienaar,
Aim: Despite clear links between unsafe sex and risk of unintended pregnancies and acquisition of HIV/STIs, effective integration of family planning (FP) and HIV/AIDS services is poor. This is especially problematic in South Africa given its high HIV prevalence, high rates of unintended pregnancies, low consistent condom use, high hormonal injectable contraceptive use, and limited access to female condoms. Health services related to HIV/AIDS and FP continue to be provided in a largely vertical fashion. This paper describes an innovative, research-driven approach to the development of a model for delivering integrated HIV and reproductive health services in the eThekwini District of KwaZulu-Natal Province in South Africa.
Method / Issue: A model for providing comprehensive and integrated FP, reproductive health (RH) and HIV services has been developed for testing in seven public-sector facilities in eThekwini, KwaZulu-Natal, including a hospital, Community Health Centre and referring PHC clinics. The model has been informed by facility assessments, baseline data collected from key informants, health providers and clients, and ongoing health service provider and community feedback.
Results / Comments: We present details of the integration model and illustrate its relevance to improving RH and HIV services in the district. The model’s overall strategy is to strengthen RH services in facilities by expanding FP method choice and promoting emergency contraception, dual protection and female condoms. Extensive capacity building involves training and mentorship of healthcare providers and training of non-clinical staff and community representatives. The model supports multiple integration configurations: (1) FP into HIV services and (2) HIV testing and counselling into FP and other primary healthcare services. Interventions to address gaps at a systemic level focus on strengthening patient and commodity monitoring, and on streamlining referral systems through an innovative ‘Health Systems Navigation’ pilot
Discussion: Through forging strong relationships with community and health authorities, we are harmonising our collective efforts to improve RH and HIV services in the district. The project will provide much-needed impetus to South African policy on integrated services by generating empirical evidence on effective and feasible integration models in this setting.
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