From Evidence to Programming: GBV in the HIV and AIDS response

Maureen Obbayi; Nduku Kilonzo PhD; Lina Digolo MbChB; Lilian Otiso MbChB

The LVCT GBV/PRC team; The Division of Reproductive Health/Ministry of Public Health and Sanitation

Trocaire; The Elton John AIDS Foundation; PEPFAR/USAID 1

40M people

Constitution: right to health, RH

7.1% HIV prevalence (15-64)

Mixed HIV epidemic: general, geographic, concentrated; Gender & age disparities

Sexual violence: limited data; high prevalence - 1 in 5 women experience sexual violence (SV)

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Eastern 4.6%

North Eastern 0.8%

Rift Valley 6.3%Western 5.4%

Nyanza 14.9%

Nairobi 8.8%

Coast 8.1%

Central 3.6%

LVCT - inputs

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Scale up

Health & Community

systems

Technical support to

Govt.

Research/Piloting

Cove

rage

- ac

cess

, equ

ity (i

n bo

th d

eliv

ery

and

upta

ke);

Stre

ngth

ened

hea

lth s

yste

ms;

New

kno

wle

dge;

Quality HIV testing and counselling

Linking testing to care,

prevention, SRH

Serving vulnerable/at

risk populations:

MSMYouthPWDs

Survivors of SV

- Innovation- New service delivery models

Policy reforms action:- National strategies - Standards & indicators- Policy implementation

- LVCT Training Institute- Quality assurance of services- Programme data utilization- CSO coordination frameworks

- TIMISHA (LVCT South to south capacity building model) - Direct service delivery- Demand creation & advocacy

LVCT: an indigenous Kenyan NGO, country led, country managed, country priorities

Policy

Practice

Research

ACTION: HIV, SRH,

mental Justice

outcomes

Evidence to ACT:- Research- Piloting

LVCT’s GBV/ PRC action framework

Platforms to ACT:- Policy reforms - Systems

strengthening- Partnerships

Impetus to ACT:- Quality service

delivery- Client feedback

• Survivors of sexual violence?– VCT counsellors from Quality Assurance – Emerging PEP data

• Operational research study (2004-6) – Diagnosis: perceptions, priorities for service delivery– Intervention: standard of care, health provider training– Evaluation: uptake and delivery of care (prophylaxis,

examination, counselling)

Kilonzo et al, 2007; 2008; 2009 5

2003/4: HIV and SV?

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Diagnosis• No regulatory framework, standards or reporting

• Inconsistent service delivery, limited capacities

• Perceptions: “Lets say I have a boyfriend and am against the act, but you

can be forced. He will come at night when he knows I am there because he want to do …, and to make me to give him. He knows if he rapes me... and when others get to

know, they will reject and laugh at me saying I was raped – so I will give in” (adolescent female, 16yrs, Thika)

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Intervention• Stakeholder consultations: DRH, local HMTs• Standard of care: algorithm, protocols, procedures• Provider training• Community mobilization

CASUALTY/OPDEmergency management

PEP/EC, examination, PRC1 form STI drugs

Counseling - Trauma/crisis, HIV test,PEP adherence; preparation for

Justice system

Laboratory

HIV care: PEP management: Laboratory monitoring

PEP outcomes

on-going follow up 4/52

Evaluation in 2006 (n=386; >30% data rejected)

Data for programming..- median age - 16.5; 56%

children; 88% female- 55% - knew assailant, children

more likely (OR 6.2; p=0) - 82% EC delivery- 16% lost in client flow

Changes: - Child friendly services (Speight

et al 2006)- EC services at casualty- Social support & counselling- Strengthening referrals

from evidence to programming: research-policy-practice

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2012/14: QA & survivor retention, SRH/HIV outcomes evaluated

2011/11: PRC kit effectiveness evaluated

COE1: 2007 /10: Model for chain of evidence tested

2006: Costing of scale up of PRC services

PRC 1: 2004 /06 - Service delivery model tested

2006: - guidelines; training curricular; MOH 263 (PRC 1) medico-legal form

2012..- 84 service sites- > 1,000 health providers

trained- 15,000 survivors seen

GAPS - No knowledge of costs of

scaling up PRC by DRH

- Poor medico-legal linkages

- Effectiveness of PRC kit for justice unknown; referrals poor

- Poor PEP adherence/ SRH outcomes and retention of survivors in health care

2007: DHR Scale up plan with PRC indicators

2009/10: - guidelines 2nd edition

2011-13: aim- to strengthen medico-legal framework (SOA)

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Lessons..• HIV programmes (funds, systems, political focus) an

opportunity for GBV with good monitoring in-built

• Investment in internal and local real capacity for: monitoring, evaluation and research

• Implementation science located in local systems (e.g. commodities & supplies), structures (e.g. reporting)

• Health sector growth must be aligned to other sectors (justice, law, order)

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Some key arguments..• Invest in partnerships –

are key for policy reforms action which results in research utilization

• Resource data is essential to mobilize investment, political attention

• ‘Evaluation of service delivery’ - works with funding partners

PRC costing study – US$ 26 per survivor

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Thanking all these great individuals…