best practice and innovations by phas in accessing and supporting rural hiv/aids programmes in...
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Best practice and innovations by PHAs in accessing and
supporting rural HIV/AIDS programmes in Uganda
Dr Joanita KigoziCollege of Health Sciences, Makerere University, Kampala, Uganda.
IDI Outreach Program I Strategic General nature:
– Focuses on development of Infectious Diseases services through systematic and longer term linkages with partners.
– Partners: national/government institutions, districts, reputable NGOs, FBOs, private sector and training institutions.
– Use of the health systems approach.
IDI Outreach Program II
• Goal: To build capacity for the scale up of quality comprehensive HIV/AIDS services
• Over 40,000 Individuals in care at facilities supported by outreach programmes in Uganda
• Numerous challenges to E²S
• PHAs are critical in addressing these challenges
E²S Challenges -Programmatic• Critical shortage of HRH
• Poor management of logistics & supplies
• Manual data management systems
• Inadequate infrastructure
• Increasing patient numbers/demand for services
• Low rates of retention in care
E²S Challenges –PHA Perspective
• Access; Distance, Terrain
• Long waiting times
• Quality of service delivery
• Opportunity cost of seeking care
• Limited availability of other HIV related services; OI drugs, Family planning etc
Determinants of Loss to follow up (LTFU)
• Long distance to facility
• Long waiting time at the facility
• Large household size
• ½ of respondents could not be reached by phone or physical tracing.
Determinants of LTFU
“My greatest challenge was distance. I used to travel from far and always arrive very late hence ending up being among the last people to be served. I found it hard to get a boda boda (cycle taxi) in the late hours of the day to return home. The situation became even worse when I was transferred to school further away making it difficult to keep on coming”
PHA response• Bridging the HR
gap;– Pre- packing drugs
– Patient registration
– Completion of manual registers
– Phone calls and physical tracing for clients LTFU
PHA response II
• Health education;– Drug adherence
– Positive living
– Positive prevention
– Appointment keeping
PHA response III
• Mobilisation;– HCT– Care Outreaches
• Sensitisation– HIV/AIDS services– Positive living– Positive prevention– Anti stigma
campaigns through drama and testimonies
Tirwomwe Association “The AIDS scourge is not just for one person”
• 50 PHAs with a Chairman & working committee
• Origin;– Chairman facilitated to access ARVs for group
from facility 35 KM away
– Support positive living, ART adherence and retention in care and advocacy for services
Progress Tirwomwe association
• Advocacy for ART services
• Meals during ART outreach clinics– <0.5 USD/mth,
food & firewood in kind
– Members cook on clinic days.
Tirwomwe association today
• Nearby facility accredited to provide ART services
• Association supports over 200PHAs– Drama group; health education, community
sensitization– Village visits, home visits. – Low rates of LTFU.– Good adherence to ART.– Reduction in stigma
Summary• PLHIV critical to E²S of rural HIV/AIDS programmes
• Recognition and support for PHA innovations should be a major objective for national HIV/AIDS programmes
• It also recognizes the GIPA (Greater Involvement of People with HIV/AIDS) principle which is critical for sustainability and social responsibility of HIV/AIDS programmes
• The common phrase by PHAs- “There is nothing for us without us” – makes their involvement in E2S initiatives more necessary
Thank you
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