Key HIV/SRH Materials and Findings

AVAC developed the following resources to advance the use of evidence-based methods for integration in programs and policies.

• Catalyzing action on HIV/SRH integration: lessons from Kenya, Malawi, and Zimbabwe to spur investment (2022): In this commentary, published in Global Health Action, MOH officials in Kenya, Malawi and Zimbabwe and global health professionals, including AVAC and Georgetown University Center for Innovation in Global Health, join together in a call to catalyze actions by development partners in support of national strategies to integrate HIV prevention and SRH information and services. This commentary complements a manuscript on findings from integration in Kenya, Malawi and Zimbabwe written by the same co-authors (below).
• Integration of HIV prevention and sexual and reproductive health in the era of anti-retroviral-based prevention: Findings from assessments in Kenya, Malawi and Zimbabwe (2021): AVAC, MOH representatives in Kenya, Malawi and Zimbabwe, Pangaea Zimbabwe AIDS Trust (PZAT) and Georgetown University Center for Innovation in Global Health published an article in Gates Open Research that comparatively analyzes findings from rapid assessments in Kenya, Malawi and Zimbabwe to highlight progress on HIV prevention and SRH integration. The article found that across countries, the policy environment is conducive to HIV prevention/SRH integration, though operationalization presents ongoing challenges, with most policies preceding and not accounting for oral PrEP rollout. National coordination mechanisms, youth-friendly health services and prevention of mother-to-child transmission programs are promising practices, while siloed and resource-constrained health systems, limited provider capacity, underfunded demand generation and structural factors exacerbate barriers to achieving integration. A related commentary was published in 2022.
• Monitoring Progress Towards PrEP-FP Integration (2021): Authors from the OPTIONS, PROMISE and CHOICE consortia, including AVAC’s Jessica Rodrigues, recently published an article, “Integrating oral PrEP into family planning services for women in sub-Saharan Africa: findings from a multi-country landscape analysis” in Frontiers in Reproductive Health. In the piece they share their desk review to develop a PrEP-FP integration framework—as integration of HIV and family planning services sees a renewed focus for national policy makers, donors, and implementers in sub-Saharan Africa. In the authors’ analysis, none of the countries included had made substantial progress toward integrated PrEP-FP service delivery. Check out the article for a road map for policy makers, program implementers, and health care providers to assess and monitor progress toward PrEP-FP integration. This work complements AVAC’s ongoing SRH/HIV integration work.
• Integration of HIV prevention and SRH services in Zimbabwe (2020): Findings from an assessment of HIV prevention and SRH integration in Zimbabwe, conducted in collaboration with the Ministry of Health and Child Care, comprised of site visits to health facilities, key informant interviews, civil society dialogues and a policy review.
• Integration of HIV prevention and SRH services in Kenya (2020): Findings from an assessment of HIV prevention and SRH integration in Kenya, conducted in collaboration with the Ministry of Health, comprised of site visits to health facilities, key informant interviews, civil society dialogues and a policy review.
• HIV & SRH Integration: Key Learnings from Research and Projects (2019): Compilation of top learnings on and approaches to implementing HIV/SRH integration in sub-Saharan Africa, drawn from literature reviews, qualitative interviews, and an analysis of policy requirements for PrEP and family planning providers.
• Exploring Integration of Family Planning and HIV Services (2019): A literature review to identify existing knowledge on barriers and enablers to the integration of HIV and family planning services in sub-Saharan Africa, in order to understand the feasibility of providing existing and new HIV prevention options and services in family planning settings.
• Applying Lessons from Family Planning to HIV Prevention Product Introduction (2018): An analysis of lessons and data from family planning in sub-Saharan Africa to better inform introduction of HIV prevention products and integration of HIV prevention into family planning settings.

Key Findings on Policies

• Policies on age of consent for HIV and SRH services in many high-burden countries are inconsistent and lack clarity, particularly for oral PrEP, and should be aligned to facilitate integrated services.
• While family planning policies allow tasks to be performed across cadres of providers, that’s not the case in HIV services. Many countries require doctors or ART/PrEP-certified nurses to prescribe PrEP. Policies that permit task-shifting are critical to reduce barriers to integrated service delivery.
• The Global Gag Rule, a US foreign policy, has constrained the provision of HIV prevention and SRH services globally. Evidence-based policies and stable funding support comprehensive service delivery.

Key Findings on End Users

• Adolescent girls and young women (AGYW) are more receptive to messaging around pregnancy prevention, making family planning a point-of-entry for conversations on HIV prevention.
• AGYW tend to attribute side effects to oral PrEP when also using contraception or STI treatment. Approaches such as peer support groups with early PrEP adopters, counseling on continuation, and highlighting similarities with contraceptive side effects have been well-received by new PrEP users.
• AGYW respond to consistency in health facility staff, rapport, privacy and respect. HIV/SRH integration can increase trust and confidentiality for clients.

Key Findings on Providers

• Non-clinical staff, i.e. “health systems navigators” and “mentors,” can be responsible for outreach, education, counseling and referrals. This lightens the burden on providers when services are integrated.
• Integration “champions” can motivate other providers with similar backgrounds (i.e. age, cultural upbringing) to promote all services.
• Mentorship and peer outreach via SMS/WhatsApp are instrumental to reinforce provider skills and encourage continued learning.

Key Findings on Service Delivery

• Investing in provider training on values and attitudes promotes empathetic and people-centered care.
• Synchronizing refills of PrEP and contraception encourages continued use of both products among AGYW clients.
• Accompanied referral, fast-tracking youth, and youth-friendly centers are low-cost models for integration that fit young people’s needs and lifestyles.

Key Findings on Health Systems

• Non-traditional settings, outside the clinic, may be preferable to many AGYW seeking health services.
• Expanding PrEP training to reproductive, maternal, neonatal, and child health (RMNCH) providers and other nurses will help alleviate pressures on over-burdened health systems.
• Integration of monitoring and evaluation (M&E) tools and registers can enhance planning, accountability, and client monitoring.