Project

AIDS, Population, and Health Integrated Assistance (APHIA II) Operations Research Project

The APHIA II OR project tested new strategies for improving access to quality services for reproductive health, family planning, and HIV and AIDS in Kenya.

The Issue

While Kenya has made remarkable improvements in HIV and AIDS care and family planning, significant challenges remain. APHIA II operations research aimed to improve services for vulnerable populations, including adolescents involved in alcohol or substance abuse; those engaging in high-risk sexual behaviors; and married adolescent girls seeking access to comprehensive sexual and reproductive health services. Approximately 40 percent of APHIA II activities addressed the needs of adolescents.

The Progress

APHIA II was a three-year cooperative agreement with USAID that built on the strong research foundation established by the Council’s previous USAID-funded OR projects (Horizons and Frontiers in Reproductive Health). APHIA II implemented projects under seven thematic areas:

  • Alcohol/substance abuse and HIV risk
  • Pediatric HIV and AIDS care
  • RH and HIV clinic systems strengthening and integration
  • Community services
  • Meeting the needs of adolescents
  • Gender, reproductive health, and HIV
  • Communication about, use of, and capacity building regarding these services

Council researchers worked closely with Kenya’s Ministry of Health and other project partners to explore the reasons behind some of Kenya’s health and service problems and to develop and test new approaches to solving them.

The Impact

APHIA II improved a number of HIV and AIDS, reproductive health, and family planning programs and influenced related policies and programs. Major milestones include:

  • During the activities of “Linking HIV-positive family planning clients to ART treatment and care services,” 93 percent of the HIV-positive family planning clients at comprehensive care centers had been referred from the maternal and child health/family planning unit of the same facility. This was a result of two highly effective strategies the Council developed: a detailed referral directory for providers, and the use of triplicate copies of referral forms given to the client by the referring provider.
  • As a result of activities during “Strengthening the delivery of comprehensive RH services through the community midwifery model,” the number of clients receiving contraceptive implants from certified midwives (CMs) increased more than 20-fold by the time of the final evaluation, and the number of clients receiving IUDs from CMs more than doubled.
  • Through a project on “Assessing the acceptability of conducting routine screening for intimate partner violence (IPV) in public health care settings in Kenya,” an IPV taskforce was established at Kenyatta National Hospital. The taskforce developed an IPV screening tool that was assessed for its utility to be used routinely in various hospital clinics attended by women and girls.
  • Having participated in research during “Integrating alcohol risk reduction in HIV counseling and testing” and seeing the successful outcomes, Liverpool VCT (a local HIV and AIDS service delivery organization) has continued with the project’s model and use of the screening tools and has adopted alcohol-risk reduction counseling into its activities.
  • As a result of the dissemination of findings from the “Positive action for HIV in schools” project, Kenya’s Ministry of Education expressed its readiness to use the information to provide guidance to schools on how to communicate with students on HIV-related issues through age-appropriate, youth-friendly channels.
  • The project “Expanding access to comprehensive RH/FP and HIV/AIDS information and services for married adolescent girls” developed a highly effective media campaign, including a radio soap opera entitled Chakrouk. The show was so popular that the entire series was repeated twice on three different FM stations. Chakruok also won a 2011 “Radio for Peace-building Africa” award in the “Gender” category, and continues to reach tens of thousands of listeners.
  • APHIA II researchers conducted a secondary analysis of the 2008/2009 Kenya Demographic and Health Survey data sets to identify the trends, differentials, and determinants of family planning use among young women in Kenya. This analysis helped guide the review of the 2003 Kenya Adolescent Reproductive Health and Development policy by the Kenya National Coordinating Agency for Population and Development, and to guide the development of a girl-centered model in the context of family planning provision in Kenya. The findings were published and the report was circulated widely. Kenya’s Division of Reproductive Health adopted the report and used it in its own presentations to development partners.

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