Abstract
Background: Though substantial progress has been made to curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. With the scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon, countries have a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV/SRH services. Methods: This article is a comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi and Zimbabwe to highlight cross-country trends and context-specific realities around HIV/SRH integration. The analyses in Kenya and Zimbabwe were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager project and include 20 health facility assessments, 73 key informant interviews and six community dialogues. In Malawi, the analysis was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 key informant interviews and a review of national policies and program implementation in Blantyre. Findings were validated through a review of literature and policies in each country. Results: The policy environment in all three countries is conducive to HIV/SRH integration, though operationalization continues to present 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, lack of support for demand generation and structural factors exacerbate barriers to achieving integration. Conclusions: As new HIV prevention products are introduced, demand for integrated HIV/SRH services is likely to grow. Investing in HIV/SRH integration can help to ensure sustainable, government-led responses to the HIV epidemic, streamline service delivery and improve the health outcomes and lives of AGYW.
Highlights
Though substantial progress has been made to curb the HIV epidemic over the past decade, high rates of new HIV infections persist, especially among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA), who in 2019 had approximately three times the HIV incidence rate of their male counterparts.[1]
Enabling environment and policy implementation Our analyses revealed that the policy environment in all three countries is conducive to expanded integration of HIV prevention and sexual and reproductive health (SRH), though most policies on integration preceded oral pre-exposure prophylaxis (PrEP) rollout
Sub-national Ministries of Health (MOH) departments for HIV and family planning (FP)/reproductive health (RH) are critical for cascading operational changes down to facilities, yet they often work in silos, resulting in parallel budgets, workplans and monitoring and evaluation (M&E) systems
Summary
Though substantial progress has been made to curb the HIV epidemic over the past decade, high rates of new HIV infections persist, especially among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA), who in 2019 had approximately three times the HIV incidence rate of their male counterparts.[1]. With the scale up of oral pre-exposure prophylaxis (PrEP) and introduction of multiple novel HIV prevention products on the horizon, health systems are at a turning point, with an opportunity to expand new and innovative approaches to reach AGYW with comprehensive HIV/SRH services, including expanding access to existing and future PrEP products. Though substantial progress has been made to curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. Methods: This article is a comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi and Zimbabwe to highlight cross-country trends and context-specific realities around HIV/SRH integration.
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