How HIV/AIDS scale-up has impacted on non- HIV priority services in Zambia
Presented by Joseph Simbaya (Zambia).
J. Simbaya1, A. Walsh2, P. Ndubani1, P. Dicker2, R. Brugha2,3, Global HIV/AIDS Initiatives Network (GHIN)
1University of Zambia, Institute of Economic and Social Research, Lusaka, Zambia, 2Royal College of Surgeons in Ireland, Division of Population Health Sciences, Dublin, Ireland, 3London School of Hygiene and Tropical Medicine, London, United Kingdom
Background: To-date, evidence on whether or not HIV scale-up has stimulated scale-up of other priority services has relied on correlation (ecological) studies. These usually fail to account for the ecological fallacy, whereby reported changes in non-HIV service outputs may be taking place at other facilities, and not at those where HIV is scaling up. We conducted intra-facility analyses in Zambia to provide better evidence.
Methods: Client numbers and trends (2004-07) for selected HIV and non-HIV priority services were extracted from registers in 41 health facilities across 3 districts: 2 urban (including Lusaka) and 1 rural.
Results: Client numbers on antiretroviral treatment (ART) in 24 facilities rose from 8,843 in 2004 to 44,311 in 2007. These accounted for 54% of all ART clients reported in Zambia in 2004, falling to 30% by 2007. ART coverage levels rose from 10.5 % (2004) to 47.2% (2007), in line with nationally reported data. District summary trends show client numbers and coverage levels increasing for family planning, antenatal care and childhood immunizations (DPT3). Intra-facility analysis of trend changes (2005-07) showed anticipated positive (Spearman rank) correlations of numbers of PMTCT clients with antenatal care (0.50) and family planning clients (0.33). Unexpectedly, there were positive correlations between upward trends in client numbers on family planning and those on ART (0.83), and family planning and HIV Voluntary Counseling and Testing (0.38).
Conclusions:Analyses that compare service performance within facilities provide evidence to support the hypothesis that facilities that get more clients into HIV/AIDS care programs reach more clients with other priority services. Reasons may include: more people seeking care from these facilities and increased cross referrals within facilities. It may also reflect health systems capacity strengthening as a result of HIV funding. These analyses need to be replicated on a larger scale.
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