Leveraging Community based Organizations to Increase...
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Leveraging Community based Organizations to Increase Demand for Clinical Services in Hard- to-Reach Populations in Mozambique Daniel D. Lee 20 July 2014
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Transcript of Leveraging Community based Organizations to Increase...
Leveraging Community based Organizations to Increase Demand for Clinical Services in Hard-to-Reach Populations in Mozambique
Daniel D. Lee 20 July 2014
What role do communities play in
providing HIV services to hard-to-reach
populations in Mozambique?
2
Mobilizing Communities to Improve ART
Main Challenges
• High HIV prevalence
• Low ART coverage
• High lost to follow up (LTF)
• Gender inequalities
4
Forces for Change
• Communities mobilized
• MoH HIV Acceleration Plan
• PEPFAR Gender-Based Violence (GBV)
Response Initiative
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Intervention Response
• Focused on strengthening HF – Community linkages
• Sub-grants for community-based organizations (CBOs)
• Demand generation (BCC, HIV C&T) • Patient outreach for ART patients LTF • GBV screening & linking victims to services
6
Objectives
• Increase community demand for HIV and related primary health care (PHC) services
• Improve ART retention • Increase GBV awareness and access to
services
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8
Increasing Community Demand
Dissemination of health education and BCC messages
Community HIV Counseling and Testing
Distribution of IEC materials to raise awareness
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• Identify ART patients lost to follow-up
Health Faclity
• Link contact info to CBO activists
Community
• Visit HHs, counsel and refer back to TTx
Household
Hard-to-Reach Population: ART patients LTF
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Hard-to-Reach Population: GBV victims
Link GBV victims to social and legal
services
GBV community awareness raising,
screening and referral
Post-GBV care services, including HIV C&T, PEP, and
counseling
Legal /Social Services Community Health Facility
Developed and reproduced IEC materials
Matched 4 activists to each HF with ART
Recruited and trained activists
Design & Implementation Process
Developed and reproduced M&E tools
Signed SAs with 8 CBO partners
Heal
th F
acili
ty L
evel
• ID ART patients LTF
• Distribute contact info to activists
• Hold health promotion meetings between HF & comm. leaders
Com
mun
ity L
evel
• Disseminate health edu. & BCC msgs.
• HIV C&T
• GBV screening
• Referrals to access HF, legal & social services
Hous
ehol
d Le
vel • Outreach
services to refer LTFs back to HF
• HIV C&T targeting partners and children of HIV+ patients
• GBV counseling
Results Achieved (LoP)
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50,769
37,360
26,504 21,899
0
10,000
20,000
30,000
40,000
50,000
60,000
Nº
of P
atie
nts
LTF Patient Outreach Cascade
Nº LTF Nº Actively Searched Nº Located and Referred Nº Arrived at HF
Results Achieved (LoP)
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101,602
37,660
0
20,000
40,000
60,000
80,000
100,000
120,000
Nº
of In
divi
dual
s
Demand Creation for HIV Services
Referred by Activist for PHC services at HF Arrived at HF
Results Achieved (LoP)
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140,797 126,785
10,876 8,427 6,204 0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Nº
of In
divi
dual
s
Community HIV C&T Cascade
Counseled Tested HIV+ HIV+ Referred to HF HIV+ Referred to HF and Enrolled in Care
Results Achieved (LoP)
• 20,594 individuals have received GBV BCC messages at community level
• 1,168 individuals received post-GBV screening and referral
• 174 have received post-GBV care
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What role do communities play in
providing HIV services to hard-to-reach
populations in Mozambique?
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Driving Question
Lessons Learned
• Hard-to-reach populations most effectively reached by activists (“expert patients”) from their own communities
• Patient outreach important but more effective to prevent LTF by organizing social support networks
• HIV C&T at community level most effective when targeting high risk HHs (case index finding)
• Effective GBV service provision requires interventions across the continuum care
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Acknowledgements
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CBO partners • Kupedzana • Kugarissica • Kuwanguisana • AIPDC • MBERI • Kupulumussana • Ademucha • Igreja Anglicana
