20th International AIDS Conference - Melbourne, Australia


MOAE0102 - Oral Abstract

Integration of HIV and nutrition services - action and measurement

Presented by Barbara Ulrike Elisabeth Engelsmann (Zimbabwe).

B.U.E. Engelsmann1, S. Chiruka1, C. Zvandaziva2, F. Assefa2, D. Patel1

1Organisation for Public Health Interventions and Development, Harare, Zimbabwe, 2United Nations International Children's Emergency Fund, Harare, Zimbabwe

Background: Good nutrition slows HIV disease progression, and advanced HIV disease negatively affects nutritional status. Despite this mutual dependence, HIV and nutrition programmes are largely implemented in a vertical fashion.
As part of a three country program (in Zimbabwe, Malawi and Mozambique) funded by CIDA through UNICEF, the Organisation for Public Health Interventions and Development (OPHID) Trust, implemented a three year program integrating service delivery for HIV and nutrition services.
Description: The program supported the linkage of four program pillars - infant and young child feeding (IYCF), prevention of mother to child transmission of HIV (PMTCT), community-based management of acute malnutrition (CMAM) and paediatric HIV treatment services - in 32 sites in two rural districts (Marondera and Hwedza) in Mashonaland East Province in Zimbabwe from July 2011 to June 2014. The program raised awareness and ownership through sensitization activities at national, provincial, district and community level; facilitated bi-directional linkages and referral systems, supervised and mentored the quality of integrated service provision using specifically defined integration indicators.
Lessons learned: For the time period January 2012 to December 2013, the program cumulatively enrolled 37015 children < 2 years, of which 6001 were HIV-exposed. The provision of integrated services progressively improved, as shown by the integration monitoring indicators in the Table.

Indicator for service integrationJan-Jun 2012Jul-Dec 2012Jan-Jun 2013Jul-Dec 2013
% of HIV-exposed infants attending DPT3 immunization who are exclusively breastfed65% (538/824)85% (909/1065)74% (741/1004)93% (1101/1186)
% PMTCT clients with children under 2 years of age receiving at least 2 IYCF counselling sessions77% (1517/1967)85% (1708/2018)90% (1133/1254)92% (1361/1472)
% CMAM clients with children under 2 years of age receiving at least 2 IYCF counselling sessions52% (485/934)55% (661/1194)86% (358/416)94% (432/461)
% children < 2 years with SAM receiving HIV-testing29% (34/118)42% (110/260)56% (40/72)70% (71/102)
% of HIV-exposed infant who received virological testing in the first two months of life52% (330/638)33% (382/1146)61% (394/651)67% (491/736)
% of children < 2 years testing positive enrolled on ART at PMTCT31% (15/49)53% (57/107)49% (38/77)61% (86/140)
[Service integration]

Conclusions/Next steps: The concept of integration can be adopted by health care workers with minimal additional resources. Indicators monitoring the integration of service provision, although more complex by virtue of measuring the association of two services, can be an important tool to sensitize and motivate HCWs to provide the desired services in a linked manner. More attention will need to be given to national routine monitoring and evaluation tools to include measures of integration.

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