GIPA/MIPA in ICAP-Tanzania

ICAP Tanzania ExperiencePresented by Mihayo M. BupambaICAPAM - Kigali 19th – 22nd Oct. 09

Peer Education (PE) program is among the four (4) strategies applied by ICAP to maximize adherence & psychosocial support to PLHIVIncrease knowledge and skills of HCWs on adherenceEstablish peer educationEstablish facility-community partnershipDecentralize adherence support activities at different

level Coverage is 180 PE in Kigoma, Kagera, Pwani

and Zanzibar in 35 C&T sites

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.

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

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 volunteerPreferred: Member of PLHIV network; previous experience

in voluntary work.

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

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

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

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

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)

DefaultersMissed Appointments

455

Lost to Follow up 786Total Defaulters 1,241

Found Alive 616 Died 140Could not be traced 485

Region

# missed appointm

ent or LTFU

# foun

d 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

Results of Defaulter TracingN= 1,241

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%

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)

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

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

ASANTENI SANA!