Working Group_M&E_5.7.14

CORE Group Global Health Practitioner ConferenceMay 7, 2014

Gloria Ekpo, MD, MPHWorld Vision

Background

Key strategies

Key intervention

Results

Lessons learned and best practices

HIV infection initially perceived as a single disease entity

Cross-cutting health problem within the “continuum of care” framework

Integrated platform delivers most cost-effective impact on maternal, newborn, and child health

HIV impact has ramifications: physically, socially, economically, and developmentally Prevention should be comprehensive and

multi- dimensional.

Community mobilization and participation◦ Information and literacy around care◦ Behavior change

Competency-based capacity building◦ A quality skill set

Simplifies models and tools◦ Advocacy: Citizen Voice and Action (CVA)◦ Timed and Targeted Counseling (ttC)

Referral and linkages: ◦ formal and informal

Ongoing advocacy

Integrated platform of service delivery:◦HIV/TB, MCHN, RH/FP◦Economic strengthening

Task shifting for increased access to services◦Health Surveillance Agents, Community

Expert Clients, ◦Behavior Change Agents

Sustainability:◦Community ownership◦National/Regional ownership of programs

Use of innovations Partnerships and collaborations

Keeping the flame of HIV prevention burning

Health facilities and community services should be complementary

Select Interventions

◦ Prevention of mother to child transmission (PMTCT)◦ Pediatric HIV◦ Voluntary Medical Male Circumcision (VMMC)◦ HIV/TB co-infection◦ Health Systems Strengthening

Scaling Up InnovationsScaling Up Innovations

Use of innovations:• mHealth, SMS, IEC, mass media, talk shows

Cross cutting areas:•Integrations within MCH, FP, healthy timing and spacing of pregnancy (HTSP)

Specific Program Area ActivitiesSpecific Program Area Activities(In partnership and collaboration with donors and (In partnership and collaboration with donors and stakeholders) stakeholders) PMTCT (Prevention of Mother to Child Transmission of HIV)•Create demand for c-PMTCT program at the community level •Increase early identification of children exposed and infected with HIV •Build capacity of NGOs/CBO, FBOs, community health workers/volunteers, on c-PMTCT•Improve adherence support for women and children on treatment•Improve follow up and tracking of mother-infant pair in c-PMTCT•Strengthen community-facility referral and linkages for essential services in a continuum of care.

• Increase male involvement in PMTCT• Strengthen mother support groups for PMTCT.• Identify and equip “champions” for PMTCT issues

Core Models Linked to the Four Prongs of the Global Plan for PMTCT

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PreventPregnancy (HIV+)

Prevention

(General)

PreventVertical

Transmission

Care for HIV+ Mother and Children

ttc ttc

LLA LLA

VBLS VBLSCCCCOH

COH

CCC

C-Chang

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C-Change

CCM

MSGMSG

ttcCCM CCM

ttc

MSG

LLAC-

Change

LLAC-

Change

ttC-timed & targetted counseling; CCM-community case management; VBLS-value-based life skills; COH-Channels of Hope; CCC-community care coalition; MSG-male support group; LLA-local level Advocacy

• Implemented in collaboration with development partners and the Government of Uganda

• A workplace-based HIV and AIDS intervention for public sector workers in the Ministry of Education and Sports (MoES), Ministry of Internal Affairs (MoIA), and Ministry of Local Government (MoLG).

•  Over 460,197 reaches with prevention messages

• Over 222,143 received access to HIV counseling, testing, and results

• Over 40,453 clients circumcised, to date

• In FY 2014, over 342 women enrolled on eMTCT Option B+.

Supporting Public Sector Workplaces to Expand Action and Responses Against

HIV/AIDS Project

• Zambézia, Mozambique

• HIV integrated with malaria, MCH, WASH, and economic strengthening

• 48,927 clients tested for and received their HIV test results

• FY 2013: SCIP registered over 32,600 pregnant women for antenatal care; 94% of these delivered in the hospital.

• FY 2010-2013: community delivery by pregnant women remained low at 20%, while hospital delivery increased from 25% to over 70%

• 3,169 clients were lost to care 2010-2013• 65% were found and 80% of these returned

to care.   

Strengthening Communities through Integrated Programming (SCIP) Project

Specific Program Area ActivitiesVoluntary Medical Male Circumcision/Early Infant Male Circumcision (VMMC/EIMC)• Create demand for VMMC/EIMC• Education and health promotion• Pre-operative counseling and education • Screening for STI and TB• HIV testing and counseling on circumcision • Ongoing support to allay fears, respond to pain and

concerns regarding fertility and sexual activity• Strengthen male and partner support group for

VMMC• Support on-going advocacy on VMMC issues

• Identify and equip “champions”

Inmates during a pre-circumcision session at the VMMC Outreach/camp at Mbale Prisons, 2013

VMMC Outreach VMMC Service Outreach includes:•Education and health promotion•Pre-operative counseling, education and screening•HIV testing and counseling•Circumcision•Post-circumcision counseling•Post-operative follow up and monitoring

Combination Prevention and Combination Prevention and Behavior Change in UgandaBehavior Change in Uganda• 3.7 fold increase in BCC messages to beneficiaries from

FY 2009 to FY 2013 • 38,000 in 2009 to 140,000 in 2013

• HCT increased 2.3 fold over same period • 31,903 in 2009 to 73,896 in FY 2013

• VMMC increased 22.6 fold over one year of implementation • 1,348 in FY 2012 to 30,453 in FY 2013

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Total new and repeat clients served through Sept.2013 188,221 in 265 health facilities

• Critical components of STEPS OVC intervention were adherence to care assesses in six different areas.

• In FY 2013:• Provided HIV prevention messages to 172,767

individuals

• Counseled and tested 228,813 people

• Registered 335,881 OVC in partnership with 388 local CBOs and FBOs

• 31,566 PLHIV on received ART including pregnant women in PMTCT programs and children infected with HIV

Sustainability Through Economic Sustainability Through Economic Strengthening, Prevention and Support for Strengthening, Prevention and Support for Orphans and Vulnerable Children (STEPS Orphans and Vulnerable Children (STEPS

OVC)OVC)

Between October 2010 and March 2013:A total of 41,986 volunteers (36% M, 64% F); Visited 97,000 HIV-positive clients aged 18 years and older (35% M, 65% F)

Six core PwP areas:1. ART adherence

2. Sexual behavior risk

3. HIV status of household members

4. Sexually transmitted infections (STI) awareness

5. Family planning considerations

6. Referrals for additional support

Post-training, volunteers were more likely to provide all six core PwP services to clients.

Assessment of HIV status of household members increased from 15% to 37%

Five times more likely to provide ART adherence counseling

5.3 times more likely to conduct an assessment of family planning

needs after training

Referrals for further support: Five-fold increase

Assessment of sexual behavior: Three-fold increase

Awareness of STIs: Three-fold increase

Network of community resource people committed to visiting/supporting people on treatment

Composition: CHWs, Home-Based Caregivers, Traditional Health Practitioners, youth, FBOs, CBOs

Enrolled, trained, and supported to work at household and community level

Act to refer between community and health facility

FY 2013:•Project provided home-based care to 11,218 clients•98% were adherent to clinic appointments•1,183 out of 1,447 defaulting clients returned •Beneficiaries linked/referred to clinics increased 14-fold •Clients attending adherence support groups increased over 500%, and defaulting clients who returned to care increased almost 800%•91% retention in care after 12 months for clients at project sites compared to 76% at non-project sites•Attrition rate and loss to follow up rate decreased threefold in the project sites compared to non-project sites •Death rate decreased 2.5 fold

• 1.9% at project sites compared to 4.6% at non-project sites

Swaziland: Community-based Swaziland: Community-based Adherence and Retention in Adherence and Retention in Care Improvement in ART Care Improvement in ART Programs. Programs.

Use of integrated platform for service delivery improves access to care

Tasks shifting promotes scale up of services

Maximize potential of community resource persons

Advocacy Champions are critical to program success

Community mobilization and ownership is essential for program sustainability

Long-term commitment to programs

• Our Donors: USAID/PEPFAR; CDC and others

• Our Partners: Community Linkages Project, SPEAR, STEP-OVC

• Ministry of Health: Uganda, Swaziland, Zambia

• National Governments: Uganda, Swaziland, Zambia

• Project Managers: CLP, SPEAR, STEPS-OVC

• Participating Communities

• Clients in projects

• World Vision Project Managers

THANK YOUTHANK YOU