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1 Click to edit Master title style Using Community Counseling and Testing to Reach Men and Couples in Click to edit Master text styles Mozambique Second level Third level Nely Honwana, HIV Counseling Fourth level and Testing Program Manager, PSI/ Mozambique Fifth level Co-Authors: Dvora Joseph, Cecília Muiambo, Carmina Cuamba, Armindo Muhava, Adelaide Mahanjane HIV Implementers Meeting Namibia, June

2 Presentation Outline Background Government of Mozambique s Strategy PSI s CT Intervention Methodology of analysis Results Challenges Recommendations

3 Background Low rates of testing among general population 3% of men and 5% of women know their HIV status (DHS, 2003) Women are significantly more likely to get tested and counseled for HIV >63% of CT clients are women* Most male clients seek CT services when they suspect that they are infected due to risky behavior: 38.7% of men in * * MOH HIV Counseling and Testing Reports 2005 & 2006

4 Background, cont. Low levels of couples counseling and testing in public sector and community Only 4% of the clients tested as a couple in 2005 (MOH) 5% of clients in PSI supported CT sites tested as couples in 2008 High levels of discordancy among couples *2005 = 35% couples = positive concordance, 23% discordant (MOH) *2009 = 31% couples = positive concordance, 22% discordance (PSI) * MOH HIV Counseling and Testing Reports 2005 & 2006

5 Government CT Strategy Strategy to Accelerate the Prevention of HIV Infections (2009): HIV counseling and testing in health is a priority strategy HIV counseling and testing in health includes counseling on nutrition, malaria, hygiene and other common diseases Recommended national strategy: (1) Expand clinical CT services, expand health CT services and expand community CT services. (2) Include mass communication campaigns to promote CT services (3) Train groups of community activists to deliver credible HIV information and increase the adherence to CT, specially amongst men and couples.

6 Intervention Increase access to Community CT services (CCT) Location of activities: workplaces, public and private institutions, schools, markets, communities, and other locations of population concentration Include interpersonal communication activities focused in prevention through Community Agents and Community Leaders in CCT activities Train CT counselors in couple's counseling CCT Activity with couple/family, counselor and supervisor Promote CT services for couples and men through mass media campaigns.

7 CAMPAIGN: PROVA DE AMOR (Prove your love)

8 CAMPAIGN: HOMEM CORAJOSO ( Be courageous! A real man gets tested for HIV )

9 Data collection & Methodologies

10 Results: 2008 (Jan-Dec) 2009 (Jan-April) Fixed site CT Community CT Fixed site CT Community CT # people tested 163,601 47,034 33,041 11,344 % Men % couples Male HIV Prevalence Female HIV Prevalence Community CT increased the % of men and the % of couples in 2009, but the % of couples who test together remains low HIV prevalence is significantly lower in CCT vs fixed CT

11 Unexpected Results Very high interest in CCT from community leaders (and community members). Distance remains a barrier: CCT clients located near the health facilities are more likely to follow through with their referrals. There is a need to respect the community s customs during CCT activities in order to reach a larger number of couples: including door to door, weekends, end of the day.

12 Challenges The country s referral system requires strengthening. This difficulty is more strongly felt in CCT. The long distances between the communities reached and the health services deter users from following through with their referrals. The percentage of discordant couples is very high, need of specialized counseling and better monitoring.

13 Key Recommendations Include door to door CCT strategy as well as weekend and end-of-the-day activities to increase the likeliness of reaching couples and families together Implement communication campaigns targeting couples and men to normalize and encourage testing Merge CCT with IPC and other prevention activities to promote open discussions on HIV.

14 Key Recommendations, cont. Collaborate with partners that provide treatment and care to ensure follow-up from clients as well as holistic service provision. In a first stage, provide CCT activities in sites not very distant from health centers to ensure referrals and post test care and support. Conduct formative research to understand the underlying beliefs and barriers to HIV testing between men and couples. Train of counselors in couple s counseling, especially providing support for discordant couples.

15 Thank You