Experience from the Community Linkages Project in Swaziland_Gloria Ekpo_4.25.13


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Experience from the Community Linkages Project in Swaziland_Gloria Ekpo_4.25.13

  1. 1. CORE Group MeetingApril 25, 2013Gloria Ekpo, MD, MPHSteven Malinga, MDWorld VisionExperience from the CommunityLinkages Project in Swaziland
  2. 2.  Introduction Project Strategy Key activities FY12 Results Evaluation Findings Challenges
  3. 3.  Hhohho :9 Clinics Lubombo:8 ClinicsCommunity Linkages ProjectHIVprevalence41.1%Population<1.2m
  4. 4. Community Linkages Project (CLP): CDC-PEPFARfunded project. Project Goal: Improved quality of life ofpeople living and affected with HIV and AIDS. Two Objectives: Integrated community home-based care supportfor PLWHA Nutritional support to PLWHA and their families Two Regions: Hhohho and Lubombo Target population: 40,065 people Project duration:2010-2014
  5. 5.  Establish Functional Link: Community ClinicCommunity using community Expert Clients Strengthen existing MOH & community healthstructures and Resource Persons Facilitate supportive community supervision, andmentoring of health services Strengthening M&E systems at community andhealth facility levels
  6. 6.  Network of community resourcepeople committed tovisiting/supporting people ontreatment Composition:CHWs, HBCaregivers, TraditionalHealth Practitioners,youth, FBOs, CBOs etc Enrolled, trained, mentored &supported to work athousehold/community level Facilitate referral betweencommunity and health facility
  7. 7.  Provision of Home Base Care, HIV and PMTCTservices Mentoring; Provision of supplies Establishing and Strengthening Support groups Health Education, Training Provision of IEC materials Training & Mentoring RHM/HBCs Mentoring Community Expert Clients Linkages between RHM/HBCs & clinics Patient follow up and tracking.
  8. 8. FLOW OF CARE FOR COMMUNITY EXPERT CLIENTSPLHASupportGroupHospitalCommunityLevelHealthCentreCommunityExpert ClientsFacilityLevelCHWSRHMS CECHBCDoctorsNursesClinicalOfficersID PatientsLink patients toCHWs/NursesFollow Up/Adherence SupportLink Groupsto Clinic
  9. 9.  Identify patients who miss appointment &follow them up Link patients with CHWs Act as clinic focal person for CHWs Coordinate & link support groups to clinic Counseling of HIV patients
  10. 10.  12 Month ART Client Outcomes Analysed Oct-Dec 2010 Cohort (total of 2387 ARTpatients) 22 Facilites: 13 CLP sites, 9 Non CLP sites 6 Manzini, 8 Hhohho, 8 Lubombo Evaluation Outputs: Retention Rate LTFU Rate Death Rate
  11. 11. 01,0002,0003,0004,0005,0006,0007,0008,0009,000Households visited and provided with HBCDefaulting patients that returned to carePLHIV provided with psychosocial supportBeneficiaries linked/referred to the clinicTracking Care to beneficiaries in Community LinkagesProject FY 2010-FY2012FY 2010FY 2011FY 2012
  12. 12. 020004000600080001000012000ONDJaFMAMJuJuASFY11FY12Numberofbeneficiaries
  13. 13. to follow up rate FY12Loss to follow up rate FY11Loss to follow up: Client not to care after 90 days.
  14. 14. 76.2%91.2%23.8%8.8%0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%100.0%Non CLP CLP% Active# (After 12mnths)% Attrition# (After12 mnths)
  15. 15. 18.3%6.9%0.0%2.0%4.0%6.0%8.0%10.0%12.0%14.0%16.0%18.0%20.0%NoN CLP CLP% LTFU
  16. 16. 4.6%1.9%0.0%1.0%2.0%3.0%4.0%5.0%NoN CLP CLPDeath Rate
  17. 17.  Late reporting especially by elderly CHWs Transition/Death of CHWs Tracking patients who relocate to SouthAfrica Support groups not keen on engaging onpsychosocial activities alone Absorption of CECs by MOH beingexplored Delays in Procurement of supplies
  18. 18.  CLP supported sites had higher retention rates,lower LTFU & death rates Use of Community Expert Clients is an effectiveway to link clients to and from clinics andcommunities Functional linkages from community-to-clinic-to-community is critical to adherence andretention in care for PLWHA
  19. 19.  Dr. S. Malinga, S. Benson, (World Vision) Partners: International Center for AIDS Care andTreatment program (ICAP) and local FBOs/NGOs Funder: Center for Disease Control and Prevention(CDC) Project staff and clients Ministry of Health Swaziland