Innovating for effective HIV Prevention Outcomes: The TASO Capacity building peer-to-peer model for Key Populations supported by Civil Society Fund, 2011-2012 Presentation at the 2nd HIV Capacity Building Summit, Johannesburg, South Africa March 19-21, 2013 Author: Teddy N. Chimulwa (Ms.) Team Leader, Psychosocial Services, TASO Uganda Limited
Background and context• HIV prevalence in Uganda was estimated at 7.3%, an increase from 6.4% in 2004 (UAIS, 2011).• New infections were estimated to be on the increase, with about 134,000 people newly getting infected annually (MoH, 2010)• “Know your Epidemic’, ‘Know your Response’ 2009, clearly articulates key populations as one of the key drivers of the HIV epidemic in Uganda• TASO Mission: – To contribute to a process of preventing HIV infection, restoring hope and improving the quality of life of persons, families and communities affected by HIV infection and disease.
Intervention• In 2011, TASO with support from the Civil Society Fund (CSF), implemented HIV prevention interventions in 4 districts of Wakiso, Masaka, Mbale and Masindi for 18 months.• Key population groups targeted were: – Commercial Sex Workers (CSWs), – Uniformed populations (Police and Armed Forces), – Fisher folk, – Truckers, – Incarcerated persons (IDPS) and – Out-of school youths.• The peer-to-peer model for capacity building of key populations was adopted.
Methodology and strategiesConsultation with district Sensitization of key Selection of participants tohealth office population group leadership attend Peer Educator’s trainingLinkage to key population As gate-keepers Selection criteria jointlygroup contacts To obtain buy-in developed Target setting for Initial training conducted performance measurement 1-day Monthly mentorship and performance review 3-days focusing on risk- 10 peers per Peer Educator reduction strategies per monthDelivery of HIV Preventionservice package to peers End of Project EvaluationBCC, RRC, Condom education& distribution & Referral &Linkage to Care & Treatment
Resources used• Meals, stationery and transport during training- ($6 per day per person)• Monthly transport refund and lunch for mentorship and refresher meetings (approx. $4 per person per month)• Only Uniformed personnel shared the costs of the training venue
Results (2) - The Cascade HTC being conducted for the Armed forces 296,980 pieces of condoms were distributed 87,010 3,353 (1620 (47,835 males andmales and 1733 39,175 340 Peer females females) educator tested for reached s trained HIVwith Risk 4.6%reduction positivemessages 100% positive linked to care-
Results (3) HIV Prevalence among Key Populations Incarcer Uniform Youths HIV Fisher ated ed men CSW Truckers out of TOTALResults Folk Populati & school on PartnersPositive 4 31 13 26 10 70 154 Col % 4.8 4.1 6.9 8.8 4.9 3.8 4.6Negative 79 724 176 271 194 1755 3199 Col % 95.2 95.9 93.1 91.2 95.1 96.2 95.4TOTAL 83 755 189 297 204 1825 3353 Col % 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Results (4)• Each peer educator reached 256 peers with key prevention messages• HIV Prevention service package comprised ; – safer sex, – Sexual and Reproductive Health (FP/STI), PMTCT, – HCT and – ABC – Condom education and distribution
Challenges and counter strategies (1)• Commercial sex work is not legal in Uganda – Initial efforts targeted their leaders, who then mobilized their peers• Engaging CSWs in training interrupted income generation – TASO provided a transport refund and lunch to each CSW each time they were engaged for a full day• Penetration of the uniformed personnel is bureaucratic – TASO engaged the leadership of the various uniformed personnel categories to counter this
Challenges and counter strategies (2)• Transfers amongst the uniformed – Training new Peer educators has been prioritized in the new project• Condom and HIV testing kits stock-outs – Better ordering and forecasting by implementing sites adopted
Lessons learnt (1)• Civil-Military partnerships• Modular training - convenient; enhances better acquisition of knowledge and skills and eases Monitoring of progress• Increased acceptability and uptake of HIV Prevention services• Sustainability• Strengthened referrals and linkage for SRH services and prevention technologies
Conclusion• Targeting key populations where majority of new HIV infections are occurring increases uptake of HIV prevention services,• Focus on the most affected Key population group (Truckers)• Peer to Peer methods radically enhance acceptability of HIV prevention interventions
Acknowledgements• Co-Authors: Celestine, Madina, Hannington & Gorretti, TASO Uganda Limited• The Uganda AIDS Commission (UAC)• Civil Society Fund (CSF)• TASO Management, Staff, and Volunteers• District Health Offices in the 4 districts• Target Population groups in the implementing sites