ICAP Tanzania Experience Presented by Mihayo M. Bupamba ICAPAM - Kigali 19 th  – 22 nd  Oct. 09
 
<ul><li>Peer Education (PE) program is among the four (4) strategies applied by ICAP to maximize adherence & psychosocial ...
<ul><li>To implement the UNAIDS/WHO declaration of Meaningful Involvement of People living with HIV/AIDS (MIPA) </li></ul>...
<ul><li>Sensitization to stakeholders (RHMT, CHMT, Facilities, CMAC) </li></ul><ul><li>Selection of PE based on set criter...
<ul><li>Living positively with HIV/AIDS </li></ul><ul><li>Adherent to care and treatment services at facility </li></ul><u...
<ul><li>10-day training is conducted based on ICAP manual, modified to suit Tanzanian context </li></ul><ul><li>Facilitato...
<ul><li>Welcome patients and reassure them </li></ul><ul><li>Give structured Health talks/testimonials at CTC  </li></ul><...
 
<ul><li>Give health talks/testimonies at RCHS to encourage testing and positive living </li></ul><ul><li>Assist on non tec...
<ul><li>Trace missed appointments and patients lost to follow up </li></ul><ul><li>Link patients with community-based supp...
<ul><li>Smooth mechanisms for tracking and tracing LTFU in place  </li></ul><ul><li>180 PE in 35 sites have established mo...
Defaulters Missed Appointments 455 Lost to Follow up 786 Total Defaulters 1,241 Found Alive 616  Died 140 Could not be tra...
Region # missed appointment or LTFU # found alive # not found # died Kagera 539 110 154 110 Kigoma 486 278 185 23 Pwani 19...
Results of Defaulter Tracing N= 1,241
 
Region # found alive # restarted on ART % restarted on ART Kagera 275 60 22% Kigoma 278 152 55% Pwani 53 18 30% Zanzibar 1...
 
<ul><li>Improved self-esteem, quality of services & customer care!   </li></ul><ul><li>PE ,“   We have been accepted by HC...
<ul><li>Shortage of HR to support PE at facilities  </li></ul><ul><li>Demand in C&T and PMTCT sites is huge </li></ul><ul>...
<ul><li>PE program increase clients’ adherence to care and treatment as well as enhance utilization of care & treatment se...
 
<ul><li>ASANTENI </li></ul><ul><li>SANA! </li></ul>
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GIPA/MIPA in ICAP-Tanzania

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GIPA/MIPA in ICAP-Tanzania

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

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