Academic Mentor: Dr. Lynn Atuyambe Host Institution Mentors Mr. Mark Breda Dr. Fred Magala. Final Dissemination 10 th May 2011 Imperial Royale

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1 Academic Mentor: Dr. Lynn Atuyambe Host Institution Mentors Mr. Mark Breda Dr. Fred Magala Final Dissemination 10 th May 2011 Imperial Royale Hotel

2 Partnership between Makerere University and the US Military HIV research Program HIV research and related activities in Uganda. MUWRP PEPFAR department of MUWRP Works with the district facilities Broad Areas: HIV prevention, Care and treatment services

3 Positive Prevention (PP): Interventions targeting HIV infected people to reduce transmission PP Package Partner disclosure and testing STI diagnosis and treatment PMTCT interventions including family planning Behavioral change interventions including consistent condom use Treatment Adherence: Taking ARVs at the right time, in the right dosage and right quantities

4 Client Retention: Adherence to clinic appointments Treatment Clubs: Organised groups of HIV positive persons Sharing experiences Support for adherence Support for positive prevention Farm and nutrition activities

5 Strengthen Positive Prevention Strengthen Treatment Adherence and Client Retention Coordinate 6 treatment clubs and the discordant couples group Participate in Operational research Design and implement a programmatic activity

6 Developed a functional Positive Prevention Programme Updated and Standardized Messaging Positive Prevention Constituted and managed the discordant couples group Developed a standard prevention Package for discordant couples Initiated drama as a supplementary communication strategy Trained clients to provide positive prevention messaging

7 standardized adherence messaging. Led the review of the treatment adherence and client retention programme Participated in the training of expert clients to improve their skills in follow up of clients to reduce lost to follow rates. Streamlined reporting and documentation

8 Coordinated 5 treatment clubs Developed and implemented treatment club guiding document Initiated a treatment club for young positives Developed proposal for the Sustainable livelihood project $100,000

9 Developed operational research to establish why clients being moved to second line treatment are non adherent Developed operational research to establish the most effective community mobilisation strategy for Medical Male Circumcision. Designed evaluation research and tools for Farm Project Evaluation.

10 Built partnerships Facilitated session at various workshops 3 conference abstracts (Uganda and Bangladesh) 3 newspaper articles

11 PROGRAMATIC ACTIVITY: Pilot Intervention to Increase HIV Status Disclosure to Sexual Partners Among PLHIVs at a MUWRP Supported Health Unit in Kayunga District, Uganda

12 HIV status disclosure to sexual partners 49% developing countries 79% developed countries (WHO, 2004) HIV status disclosure rate among PLHIVs 69% in TASO Eastern Uganda (king et.al, 2007) MUWRP target is 90% disclosure

13 1. To identify barriers, benefits and skills of disclosure of HIV status to sexual partners by PLHIVs. 2. To design and implement a pilot intervention to facilitate HIV status disclosure to sexual partners among PLHIVs 3. Preliminary evaluation of the pilot intervention to increase HIV status disclosure to sexual partners among PLHIVs

14 Qualitative study design Sampling procedure and selection 4 Focus group discussions (FGD) purposively selected PLHIVs 6 Key Informant Interviews (KII) peer counselors and Health Center staff

15 Understanding based on personal experience For me it brought me problems I had been with my husband for 24 years with 5 children,he refused to test and for 2 years he stopped me from going to the Dr. I left after 2 years with 3 of the 5 children and he doesn t check on us or pay their fees. In my understanding, it is a problematic thing because it made me lose my marriage. (Female FGD Participant, Bbaale HCIV) Barriers Blame Abandonment Benefits Access to treatment HIV risk reduction Partner support

16 Goal The goal of this intervention was to contribute to the reduction of the transmission of HIV Purpose Promoting HIV status disclosure among clients at MUWRP supported sites. Target HIV positive clients attending Bbaale HCIV

17 Interventionn description Guided by the diffusion of innovations/ideas theory. Among a group of 25 people Outcome would increase with an increasing dose of the intervention. 4 subtopics; understanding, barriers, benefits, and skills (1.5 hr sessions) Delivered by experienced counselors facilitators Interactive Group Methods. Participants were the agents of change.

18 Done 1 month after intervention Pre post design with a control 2 health centers Bbaale HCIV interventionn Continued to receive the routine interventions received described intervention Kangulumira HCIV Control Continued to receive the routine interventions Baseline data collected (n=196) and post intervention data collected (n=196) Client selection systematic random sampling

19 No significant differences between facility characteristics as well as baseline characteristics Age Sex Marital Status Time since first diagnosis Time spent attending clinic Knowledge of partner status Disclosure

20 Figure 1: Baseline Characteristics Variables Interventionn Control % % Age group (22) 30 (27) (40) 52(47) (32) 19(17) Sex Male 27 (25) 22 (20) Female 73 (69) 78(71) Marital status Never Married 13 (12) 24(22) Married 71(67) 60(55) Widowed/divorced 16(15) 15(14) P Value

21 Time since first diagnosis 1 year 35 (34) 34(33) 2 years 29(28) 24(23) 3 years 17(17) 18(18) More than 3 years 19 (19) 25(24) Time since started attending the clinic 1 year 44(43) 40(39) years 27(26) 26(25) 3 years 12(12) 14(14) More than 3 years 17(17) 20(20) Knowledge of Partners status 63 (59) 63(57) 1.00 Disclosure 71(70) 70(68) 0.839

22 100% 90% 80% 70% 60% 50% 40% 30% 20% P= % 88% P= % 76% Disclosure at baseline Disclosure at post intervention 10% 0% Intervention Control

23 Figure 3: Statistical significance of disclosure in intervention Disclosure in Intervention group IRR p value 95% confidence interval Note: Adjusted for Age; Sex; marital status; duration since diagnosis; duration since one started attending the clinic; and knowledge of partners HIV status.

24 1) Diffusion of information through a small group intervention can through a ripple effect increase HIV status disclosure to sexual partners in a health care system. 2) Interventions that are population driven and make individuals agents of change within their peers can be effective.

25 i) An evaluation be carried out at least 3 6 months after the intervention ii) Subsequent studies to establish the ideal ratio of small groups to population required for effective diffusion are necessary iii) This approach can be tested in populations with low disclosure levels iv) This intervention should be used with other prevention strategies

26 God Mentors Fellow fellows Alumni fellows MUWRP PEPFAR Staff Family