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GIPA/MIPA in ICAP-Tanzania

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  • 1. ICAP Tanzania Experience Presented by Mihayo M. Bupamba ICAPAM - Kigali 19 th – 22 nd Oct. 09
  • 2.  
  • 3.
    • Peer Education (PE) program is among the four (4) strategies applied by ICAP to maximize adherence & psychosocial support to PLHIV
      • Increase knowledge and skills of HCWs on adherence
      • Establish peer education
      • Establish facility-community partnership
      • Decentralize adherence support activities at different level
    • Coverage is 180 PE in Kigoma, Kagera, Pwani and Zanzibar in 35 C&T sites
  • 4.
    • To implement the UNAIDS/WHO declaration of Meaningful Involvement of People living with HIV/AIDS (MIPA)
    • Goal
    • Increase engagement of PLHIV to deliver services in clinical settings and integrate in communities.
  • 5.
    • Sensitization to stakeholders (RHMT, CHMT, Facilities, CMAC)
    • Selection of PE based on set criteria
    • Training for 10 days with supervised practicum
    • Define PE roles at CTC, PMTCT and community
    • Provide working tools/non-monetary incentives: (bicycles, T-shirts, raincoats, gum-boots, bags and torch)
    • Monthly stipends of 30,000Tsh
    • Supportive supervision, M&E
    • Data collection and reporting
  • 6.
    • Living positively with HIV/AIDS
    • Adherent to care and treatment services at facility
    • Stable health status with capability to assist services at facility
    • Good communication skills
    • Disclosed HIV status to family members and community
    • Accepted by peers and community
    • Ability to read and write
    • Willing to volunteer
    • Preferred: Member of PLHIV network; previous experience in voluntary work.
  • 7.
    • 10-day training is conducted based on ICAP manual, modified to suit Tanzanian context
    • Facilitators guide
    • Participant manual in both English and Kiswahili
    • Data collection tools
    • Scope of Work for Peer educator and involved parties (HCWs, NGO, ICAP)
    • Database is been developed
  • 8.
    • Welcome patients and reassure them
    • Give structured Health talks/testimonials at CTC
    • Provide additional adherence counselling to patients
    • Reinforce correct messages on ARV, side effects, etc
    • Promote positive living, disclosure, condom use
    • Help patients to: cope with HIV; TB infection control measures and encourage disclosure
    • Assist non-clinical activities (sorting files, tracking defaulters)
    • Escort patients during internal referrals
    • Keep records in their tools
    • Represent PLHIV in MDT meetings
  • 9.  
  • 10.
    • Give health talks/testimonies at RCHS to encourage testing and positive living
    • Assist on non technical PMTCT-related activities at RCHS (appointment books, escorting internal referrals CTC)
    • Support newly diagnosed pregnant mothers (immediately) to cope/accept status, disclosure, safer sex, condom distribution
    • Reinforce correct messages on infant feeding, SD-NVP, AZT Efficacious regimens etc.
    • Link mothers post-FSG to existing support groups in community
    • Sensitization for male involvement, EID, couple & siblings testing ,and stigma reduction
    • Track and trace defaulters (missed appt)including HEI/AZT
  • 11.
    • Trace missed appointments and patients lost to follow up
    • Link patients with community-based support services
    • Establish/strengthen support groups
    • Community sensitization and mobilization
    • Stigma reduction
  • 12.
    • Smooth mechanisms for tracking and tracing LTFU in place
    • 180 PE in 35 sites have established more than 100 peer support groups
    • Conducting monthly meetings for care and treatment clients in facilities
    • District councils involvement in APSS:
      • PLHIV members in CMAC, WMAC and VMAC
      • 16 district councils are supporting PE groups and individual PEs
      • District councils are coordinating partnership meetings
    • Facility-community partnership established and strengthened (referral mechanisms)
    • Local PLHIV NGO managing elements of program (SHDEPHA+ in Pwani and ZAPHA+ in Zanzibar)
  • 13. Defaulters Missed Appointments 455 Lost to Follow up 786 Total Defaulters 1,241 Found Alive 616 Died 140 Could not be traced 485
  • 14. Region # missed appointment or LTFU # found alive # not found # died Kagera 539 110 154 110 Kigoma 486 278 185 23 Pwani 192 53 133 6 Zanzibar 24 10 13 1 TOTAL 1,241 616 485 140
  • 15. Results of Defaulter Tracing N= 1,241
  • 16.  
  • 17. Region # found alive # restarted on ART % restarted on ART Kagera 275 60 22% Kigoma 278 152 55% Pwani 53 18 30% Zanzibar 10 3 34%
  • 18.  
  • 19.
    • Improved self-esteem, quality of services & customer care!
    • PE ,“ We have been accepted by HCW and clients attending CTC , and community by providing ,testimonies, and we have been helping some at Facilities by sorting files and weighing clients. (PE from Utete Hospital)
    • HCW , “we are supposed to be 7HWs at our CTC but hardly you will find 4or 3 to attend all patients .peer educators are now helping us with non technical work then HWs timely and properly deal with treatment aspect”. Nyakahanga health worker
    • Pts , “We feel free to talk to PE, their testimonies are very helpful in encouraging disclosure” (patient from Miono HC)
  • 20.
    • Shortage of HR to support PE at facilities
    • Demand in C&T and PMTCT sites is huge
    • Distance hinders PE to follow-up patients
    • No policy to support the intervention in HFs
    • Building capacity of PLHIV NGO to manage some elements of the program
  • 21.
    • PE program increase clients’ adherence to care and treatment as well as enhance utilization of care & treatment services
    • PE reduces workload to HCWs
    • PE programs increase self-esteem among PLHIV; reduce stigma, and enhance smooth defaulter tracing
    • PE demonstrate the success of ART,
    • PLHIV NGO are capable to deliver non-clinical care services
    • Sustainability requires working with other entities and retraining
    • District councils are willing to fund PLHIV work within the clinical settings
  • 22.  
  • 23.
    • ASANTENI
    • SANA!

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