increasing access to and uptake of hiv testing, counseling ......management sciences for health 1...

1 Management Sciences for Health

Increasing Access to and Uptake of HIV Testing, Counseling and

PMTCT Services among Women in Purdah in Resource-Limited Settings of North East Nigeria

2 Management Sciences for Health

Introduction

• Women in purdah – the seclusion of women from

public observation by using a veil and limiting

movement.

• They are segregated physically from men and only

participate in limited activities outside their home.

• More than 75% of women who don’t access

HIV/AIDS services are in purdah or have husbands

who restrict their movement.

3 Management Sciences for Health

• Facility data audit-baseline assessment of

women and men who access facility for

HTC.

• Community mobilization and Sensitization.

• Use of Voucher and Escort Services.

• Daily service registers and referrals.

• Monthly and yearly monitoring systems.

Methods

4 Management Sciences for Health

Methods-contd

5 Management Sciences for Health

Methods-contd

Advocacy Visit to Local Government Chairman in Michika LGA, Adamawa State,

Nigeria

6 Management Sciences for Health

Methods-contd

Advocacy visit to some religious leaders in two Local Government of Adamawa

State, Nigeria

7 Management Sciences for Health

Outcome of Intervention

Some women in Purdah attending Health talks and ANC at the Facility in

Adamawa State

8 Management Sciences for Health

• Five (5) couples averagely accessed facilities monthly before intervention.

• Post intervention figures after third and twelve months increased uptake to 32 and 77 couples respectively.

• In the two facilities, more couples accessed services in May, August and December due to increased sexual activity during festivals and holidays.

• GH Michika has higher uptake.

• At the end of year two, more than 1000 intending or married couples had accessed both HTC and PMTCT services.

Results

9 Management Sciences for Health

Results-contd

Jan Feb March April May June July Aug Sept Oct Nov Dec

4 6

20

12

36

12

26 26

12 14

29

118

23

49

38

48 47

38

47

52

24

29 31

117

8 5

12 10

28

15

7

28

23

16 18

34

25 28

43 41

32

22 24

13

4

9 11 11

GH Michika 2010 Michika2011 GH Garkida 2010 Garkida 2011

Number of Couples who assessed HTC at four facilities between

2010 and 2011 in Adamawa State, Nigeria

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Challenges

• Request for written documents on test

results from religious leaders.

• Inadequate staff for follow-up services with

community and religious leaders.

11 Management Sciences for Health

Ways to Overcome the

Challenges • Continuous advocacy to community and

religious leaders on confidentiality issues

surrounding HIV/AIDS in Nigeria

• Task shifting and multitasking of

volunteers in the community, churches and

mosques

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• Advocacy and community mobilization are

important tools in HTC.

• They increase knowledge of and access to

PMTCT services among women in purdah

when supported by men.

• To increase PMTCT uptake, government,

donors and NGOs should expand efforts in

advocacy and community mobilization and

engage more men.

Conclusion

13 Management Sciences for Health

• To the USAID for funding the PROACT

Project.

• The PROACT Project in Nigeria

• The State Team of PROACT Adamawa

State

• The Community Leaders in Adamawa

State especially, Michika, Song, Gombi

and Fufore LGAs

• The facility staff, LACA and MSH

community volunteers

Appreciation

14 Management Sciences for Health

Thank you

Olukunle Omotoso MPH Community HIV/AIDS Services Specialist