How HIV/AIDS scale-up has impacted on non-HIV

How HIV/AIDS scale-up has impacted on non-HIV priority services in Zambia.

Brugha R, Simbaya J, Walsh A, Dicker P, Ndubani P. BMC Public Health. 2010 10(1):540.

Much of the debate as to whether or not the scaling up of HIV service delivery in Africa benefits non-HIV priority services has focused on the use of nationally aggregated data. This paper analyses and presents routine health facility record data to show trend correlations across priority services. The authors conducted a review of district office and health facility client records for 39 health facilities in three districts of Zambia, covering four consecutive years (2004-07). Intra-facility analyses were conducted, service and coverage trends assessed and rank correlations between services measured to compare service trends within facilities. Voluntary counselling and testing, antiretroviral therapy and prevention of mother-to-child transmission client numbers and coverage levels increased rapidly. There were some strong positive correlations in trends within facilities between reproductive health services (family planning and antenatal care) and antiretroviral therapy and prevention of mother-to-child transmission, with Spearman rank correlations ranging from 0.33 to 0.83. Childhood immunisation coverage also increased. Stock-outs of important drugs for non-HIV priority services were significantly more frequent than were stock-outs of antiretroviral drugs. The analysis shows scale-up in reproductive health service numbers in the same facilities where HIV services were scaling up. While district childhood immunisations increased overall, this did not necessarily occur in facility catchment areas where HIV service scale-up occurred. The paper demonstrates an approach for comparing correlation trends across different services, using routine health facility information. Larger samples and explanatory studies are needed to understand the client, facility and health systems factors that contribute to positive and negative synergies between priority services.

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Editors’ note: Whether the scale-up of HIV services is strengthening or depleting health systems continues to be hotly debated, usually with little evidence. This analysis of three districts in Zambia based on facility level data contributes interesting evidence to the dialogue. In these three districts where rapid scaling up of the delivery and coverage of HIV services was underway the impacts on non-HIV service delivery were mixed. The most positive impacts were seen on antenatal services (the intake for prevention of mother-to-child transmission) and increased client numbers in family planning services (which can help prevent unplanned pregnancy in women living with HIV). The fact that there were fewer antiretroviral drug stockouts than stockouts of other essential medicines (e.g. malaria drugs, oxytocin to accelerate labour, ergometrine for post-partum haemorrhage) suggests spill over positive effects in supply chains were not happening. Clearly more studies are needed to tease out the interactions but already this study is showing the way, highlighting the potential to derive useful evidence from routinely collected health facility data so that national planners and district programme managers can identify and address missed opportunities for synergies.