teddy chimulwa - taso, uganda

Innovating for effective HIV Prevention Outcomes: The TASO Capacity building peer-to-peer model for Key

Populations supported by Civil Society Fund, 2011-2012

Presentation at the 2nd HIV Capacity Building Summit, Johannesburg, South Africa

March 19-21, 2013

Author: Teddy N. Chimulwa (Ms.)Team Leader, Psychosocial Services,

TASO Uganda Limited

Background and context• HIV prevalence in Uganda was estimated at 7.3%, an increase

from 6.4% in 2004 (UAIS, 2011).

• New infections were estimated to be on the increase, with about 134,000 people newly getting infected annually (MoH, 2010)

• “Know your Epidemic’, ‘Know your Response’ 2009, clearly articulates key populations as one of the key drivers of the HIV epidemic in Uganda

• TASO Mission:– To contribute to a process of preventing HIV infection, restoring hope

and improving the quality of life of persons, families and communities affected by HIV infection and disease.

Intervention • In 2011, TASO with support from the Civil Society Fund (CSF),

implemented HIV prevention interventions in 4 districts of Wakiso, Masaka, Mbale and Masindi for 18 months.

• Key population groups targeted were: – Commercial Sex Workers (CSWs), – Uniformed populations (Police and Armed Forces), – Fisher folk, – Truckers, – Incarcerated persons (IDPS) and – Out-of school youths.

• The peer-to-peer model for capacity building of key populations was adopted.

Methodology and strategiesConsultation with

district health office

Linkage to key population group

contacts

Sensitization of key population group

leadership

As gate-keepersTo obtain buy-in

Selection of participants to attend

Peer Educator’s training

Selection criteria jointly developed

Initial training conducted

3-days focusing on risk-reduction

strategies

Target setting for performance measurement

10 peers per Peer Educator per month

1-day Monthly mentorship and

performance review

Delivery of HIV Prevention service package to peers

BCC, RRC, Condom education &

distribution & Referral & Linkage to Care &

Treatment

End of Project Evaluation

Resources used• Meals, stationery and transport during training-

($6 per day per person)

• Monthly transport refund and lunch for mentorship and refresher meetings (approx. $4 per person per month)

• Only Uniformed personnel shared the costs of the training venue

Results (1)- 340 trained

Peer Educators trained by Category

CSWs

Fisher F

olk

Incarce

rated

Uniform

ed

109

29 33

169

Peer Educators trained by sex

Male; 137

Female; 203

Results (2) - The Cascade

340 Peer

educators

trained

296,980 pieces

of condoms were

distributed

3,353 (1620 males and 1733

females tested for HIV

4.6% positive

100% positive linked

to care-

87,010 (47,835 males and

39,175 females

) reached

with Risk

reduction

messages

HTC being conducted for the Armed forces

Results (3)

HIV Prevalence among Key Populations

HIV Results

CSWFisher Folk

Incarcerated

Population

Truckers

Uniformed men

& Partners

Youths out of school

TOTAL

Positive Col %

44.8

314.1

136.9

268.8

104.9

703.8

1544.6

Negative Col %

7995.2

72495.9

17693.1

27191.2

19495.1

175596.2

319995.4

TOTALCol %

83100.0

755100.0

189100.0

297100.0

204100.0

1825100.0

3353100.0

Results (4)• Each peer educator

reached 256 peers with key prevention messages

• HIV Prevention service package comprised ;– safer sex, – Sexual and Reproductive

Health (FP/STI), PMTCT, – HCT and – ABC– Condom education and

distribution

Challenges and counter strategies (1)

• Commercial sex work is not legal in Uganda– Initial efforts targeted their leaders, who then mobilized

their peers

• Engaging CSWs in training interrupted income generation – TASO provided a transport refund and lunch to each CSW

each time they were engaged for a full day

• Penetration of the uniformed personnel is bureaucratic– TASO engaged the leadership of the various uniformed

personnel categories to counter this

Challenges and counter strategies (2)

• Transfers amongst the uniformed– Training new Peer educators has been prioritized

in the new project

• Condom and HIV testing kits stock-outs– Better ordering and forecasting by implementing

sites adopted

Lessons learnt (1)

• Civil-Military partnerships

• Modular training - convenient; enhances better acquisition of knowledge and skills and eases Monitoring of progress

• Increased acceptability and uptake of HIV Prevention services

• Sustainability

• Strengthened referrals and linkage for SRH services and prevention technologies

Conclusion • Targeting key populations where majority of new

HIV infections are occurring increases uptake of HIV prevention services,

• Focus on the most affected Key population group (Truckers)

• Peer to Peer methods radically enhance acceptability of HIV prevention interventions

Acknowledgements • Co-Authors: Celestine, Madina, Hannington & Gorretti,

TASO Uganda Limited

• The Uganda AIDS Commission (UAC)

• Civil Society Fund (CSF)

• TASO Management, Staff, and Volunteers

• District Health Offices in the 4 districts

• Target Population groups in the implementing sites

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