Report for TCE Community Testing Gaza

Transcription

1 ADPP Mozambique Report for TCE Community Testing Gaza Anual Report 2016 Submitted to: Norway

2 Project Name: TCE Community Testing Gaza Organization: ADPP - Moçambique Report Period: January-December The Project at a Glance 1 Name of the project 2 Operation area TCE Community testing Gaza Districts of Bilene, Chibuto, Guija, Manjacaze, Xai-Xai city and Xai Xai district, in Gaza Province 3 Project Leader Adamo Paulino 4 Address ADPP TCE Gaza, Rua das quadras, Cidade de Xai Xai. Xai Xai, Moçambique 5 Tel. & tce@adpp-mozambique.org adamopaulino1984@yahoo.com.br 6 The project idea and who the project reaches ADPP has been implementing TCE in Mozambique since 2001, reaching out to more than 5 million people, in order to reduce the risk of exposure to HIV and to mobilize all individuals and communities, and also to involve them in the fight against this epidemic. The community testing project emphasis in on voluntary counseling and testing for HIV/AIDS in the community, thus reaching out to people to would otherwise not decide to go to a clinic to get tested. Through a family approach, HIV+ patients are asked to list all family members, to consent to home visits in their household and go through Voluntary Counseling and Testing (VCT) with nuclear family members. The annual target is to reach persons with VCT in 6 districts. Additionally the project works with health facilities to actively trace those patients who have missed treatment appointments or failed to receive monthly ARVs. The overall goal is to increase coverage of HIV Counseling and Testing in those 6 districts and also to ensure that the global defaulter rate per Health Unit covered remains at a low level. 7 A brief history From March 2013, ADPP started working with Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to promote testing and counseling of family members of the patients already enrolled in care and treatment services (Index-Case), in 6 districts (Bilene, Chibuto, Guija, Manjacaze, Xai-Xai city and Xai-Xai district in Gaza province. ADPP has many experiences working in Gaza province and some of these targets area, and is known for the quality field work, and capability to manage programs involving many people, activists and funds. 2 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

3 Project activities: ADPP through its TCE program (Total Epidemic Control) is implementing counseling and testing activities in Gaza province, through a partnership with the Elizabeth Glaser Pediatric AIDS Foundation. This Project is aligned with the United States Emergency Plan for AIDS Relief. It was designed with the aim of reducing the risk of exposure to HIV / AIDS and to actively mobilize communities in the fight against this epidemic, contributing significantly to the counseling and testing services for adherence to Anti-Retroviral Treatment ART treatment through the index case, the new Ministry of Health strategy. The retention of patients are undergoing treatment in the community, through active outreach and strengthening counseling for adherence to ART, including tracing of TB, Gender-based Violence and malnourished children, pregnant and breast feeding women. The project is being implemented in 6 districts, namely: Bilene, Mandlakazi, Chibuto, Guija, Xai-Xai and Xai-Xai town. The fundamental essence of the project is to increase the coverage of counseling and HIV/AIDS testing in communities and contribute to a reduction in global complying rates of Anti-Retroviral Treatment (ART) in the implementing districts. To achieve the objectives of the project, the project has 180 field officers, these receive the health unit s lists of patients who are undergoing treatment and visit them in their homes where they offer counseling and testing services to the remaining family members. The field officers also screen for TB, Gender-based Violence and malnutrition. In this process, patients who have positive test results as well as patients suspected of being malnourished and with signs and symptoms of TB are referred to health units. For patients with positive results, more focused counseling is given on the importance of ART. Also during the contacts with the families the field officers inform about sexual reproductive health, fidelity and the consistent uses of condoms. 3 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

4 Main project activities HIV/AIDS voluntary family testing and counseling Index Case The HIV counseling and testing process begins with the production of the list of Index Cases made by the assigned field officer focal point in the health facility. Regarding the Index Case (patients already enrolled in care and treatment services), Field Officers make home visits to patients who agree to the visits after locating them. During home visits, field officers invite other family members to speak openly about the diseases transmitted through unprotected sex (STDs), including HIV / AIDS, and the importance of each member knowing their status through HIV testing. In this process family members are tested, with particular attention to children and teenagers, meaning that all members from the direct family are tested, while only children and adolescents up to the age of 19 from non-direct family members are tested as well. The remaining members over 20 years of age are referred for testing at health facilities. Counseling and testing of indirect family children and teenagers The Index Case family approach prescribes that indirect family members of the Index Case are not tested during home visits to the Index Case but are referred for testing at the nearest health center. They are sensitized to adhere to treatment and follow medical recommendations on treatment adherence. To minimize ART side effects, once treatment is started one should not stop. During these visits, the project gives priority to children and adolescents bearing in mind that they depend on their caregivers for going for medical consultations, getting information about health issues or treatment adherence. Once counsellors are aware that children are living with HIV, they encourage their parents / care givers to accompany them to health centers for medical attention. Active tracing of ART defaulters and those who have abandoned treatment During this period in the process of carrying out the activities, field officers received lists of 11,340 patients who had abandoned ART, the field officers followed and located 4,100 and these were counselled on resuming treatment, messages about the importance of ART and the consequences that may arise when the treatment is not followed. The remaining members of these families are offered counseling, testing and screening services. Screening of TB, Gender-based Violence (GBV) and malnutrition. The process of counseling and testing by field officers also served as an entrance to address various aspects of health and provide the families with the knowledge 4 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

5 that beyond HIV there are also many diseases that can decimate our lives. The field officers also focused on malnourished children from 3 to 9 years, pregnant women and women who are breastfeeding. Families were also informed about violence, thus explaining the types of violence and the procedures that should be taken when this happens. Follow up of HIV-positive pregnant and breastfeeding women In addition to the lists received from patients who were absent and had abandoned treatment, field officers also received lists of pregnant and breastfeeding women, who were no longer following the dates of control of the consultations, they followed up on these women and counseling on ART was strengthened, the message of institutional birth was also strengthened as a way to prevent transmission of HIV virus from mother to child. Project Results Reduce the number of cases of ART treatment abandonment, which means that of the 7,371 patients who had abandoned ART, due to the Field Officers' awareness campaigns, 2,013 patients were reintegrated in care and treatment. 30,098 malnourished children were referred to health units. Given and considering that the early years of a child's life are the most important for the development and full growth of a child. The Project was involved in the lectures on Maternal and Child Health with special attention to children below 7 years of age, pregnant and lactating women. These interventions contributed to the tracking and identification of 30,098 children who were malnourished and referred to maternal and child health services, thus providing them with a better opportunity to grow stronger and healthier. Due to the project interventions, there has been a significant improvement in patient retention to treatment, through increased awareness of the importance of a positive life, adherence to treatment, HIV testing, importance of healthier behaviors given in the health units, patients undergoing treatment are also showing a better quality of life and greater adherence in taking medicines. Increase in the number of people who know their state, which means that a total of 110,836 people know their status, in the 6 implementation districts thus positively contributed to the reduction of new infections. 5 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

6 Effects of the Project Activities The families of the index cases, do the HIV test, in their own homes, without having to go to the health units. When providing other health care services in the community, we have noticed that adolescents are now able to negotiate the use of condoms. The number of home births reduced, through the follow-up and mobilization of pregnant women by field officers. It is important to note that during this period, of the 7,371 patients who had abandoned treatment we were only able to locate 5,204, which means that 2,167 were not located, mainly because of wrong addresses. Of the 5,204 who were referred to resume with treatment only 2,013 went back to the sanitary units and have resumed with treatment. In this process one of the great challenges was of wrong addresses, which made it difficult to locate the patients during the follow-up, we also found some patients who did not accept to return to for treatment because they lack the 3 necessary meals during the day. We are currently pursuing continued follow-up with a view to strengthening counselling on ART. 6 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

7 Attachment 1: The Project in Numbers People at the Project TCE Community Testing Gaza Goals and Achievements Goal for 2016 Achieve d Varianc e 1.1. Project Coordinator Deputy Project Coordinator Area Supervisors Data Capturers Field Officers Project Beneficiaries 1.6 No. of Index-case patients counseled that accepted a home visit 32,400 22,276-10, Total No of people tested for HIV HIV Testing Services 1.8. Direct family members of index-case patients tested Adherence to Treatment Services 103, ,836 97,200 84,399 7,156-12, Default patients from ARV treatment and care identified by the HF Default patients located in the community Default patients reintegrated in ARV treatment and care Other Services Provided Family members referred to HF (HIV tested+ GBV victims, contact and TB suspected and Malnutrition Children & pregnant women screened for malnutrition Family members that received prevention education on GBV Family members screened for TB in case of contact Family members referred that reached the HF (HIV tested + GBV Victims, contact & TB suspected, Malnutrition) 11,340 4,100-7,240 7,371 5,204-2,167 7,371 2,013-5,358 48,600 59, , ,000 50,096-81,904 72,900 85, ,798 97,200 99,773 +2,573 38,880 44,067 5,187 7 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

8 Comments: 1.6 The reason for the failure to reach the goal of this indicator was absent from the families during the visits, which means that in some houses we only found the children. For this reason we started to make regular visits in order to find the members. 1.7 During the year 2016, the project aimed at counseling 103,680 patients on testing, we reached 110,836 patients, equivalent to 107%, 84,399 from the direct family and 26,437 from indirect families. To achieve these results, the following aspects were considered: Availability of testing kits in a timely manner. Improved collaboration with health workers in each district and active participation in committee meetings at district level. Providing of lists of Index Cases, to Field Officers working in collaboration with the Health Services, as focal points. Participation in statistic meetings at the province level, thus showing the results the project is achieving. 1.8 we were not able to reach the target, because we had lack of test kits in January and February. As a way of solving this problem a meeting was held at the provincial and district levels, where we negotiated to get more test kits. And from the month of March there was improvement in the number of people tested. 1.9 We were not able to reach the goal of this indicator, because we had the following difficulties: False addresses, thus making it difficult to locate the persons. Some patients' had moved to new addresses, and we sometimes received lists of patients who were considered to be absent from the treatment while still active. Some health units were lacking updating the database We have not been able to reach the target in this indicator because we received a new guideline in the month of April from the partner orientation (EGPAF) that we only have to work with the lists of the patients that we received from the health units We were not able to reach the goal of this indicator, because some of the referred patients did not agree to resume the treatment, saying that the medicines made them very hungry and they do not have access to the 3 meals every day. We had some patients who did not accept to return to the health unit claiming that they are poorly attended by the health professionals 1.13 We had other indicators that we could not reach, such as pregnant and lactating women and children, where the target was of 132,000, reaching only 50,096 because we worked with pregnant and lactating women in the first and second trimesters, then the partner trained a Specific group of health educators who started working with this target group. 8 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

9 Attachment 2: Photos from the Project Benilde, field Officer counselling on ARV adherence in Chicumbane Field Officers compiling data at the Health Center in Xai Xai 9 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

10 Field Officers during planning meeting at the Health Center in Xai Xai Field Officer testing a child in Licilo, Chissano Administration post in Bilene District 10 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

11 Cremilda, Field Officer making a list of abandonment at the rural hospital in Manjacaze Field Officer cross-checking data at the Health Center in Guija 11 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

12 Field Officer testing a breast-feeding woman at the Mobile Clinic in Manjacaze Field Officer making Index Cases at the Health Center in Chibuto 12 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

13 Eduvaldo, Field Officer testing a member of Index Cases in Bairro 3 in Macia Field Officer testing a nuclear family in Bairro Maria Gubine in XaiXai 13 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

14 Field Officer testing a breast-feeding woman in Bairro 3 in Macia Lucia, field Officer making follow up visit in Bairro 1 in Macia 14 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

15 Attachment 3: Documents from the Project Recommendation Letter from the district government applauds the work being done by TCE on mitigating and combating HIV/AIDS focusing on testing and counseling. The program is highly contributing to improve the health of the community. Not forgetting that the program positively contributes to the retention of patients on treatment through active searches of dropouts, abandoning patients and reinforce counselling, to continue ART treatment. It is with pleasure that we recommend ADPP for their demonstrated ability during their actions in the district of Bilene in mitigating and combat of HIV/AIDS mainly focused on counselling and testing where they have proved to having valuable performance to reach the goals in this area. 15 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a

16 The International Immigration Organization (OIM), has been implementing activities in Gaza Province for several years in health, against human traffic, response to humanitarian emergencies, and gender based violence. Under the oath of the department of labor migration and human development, migration and health financed by the European Union partnering for Southern African Health Mobility and Oriental I HAMESA, OIM Mozambique in partnership with the Ministry of Health through the district department of health in Gaza and other partners intends to put through an end of year campaign called Healthy Holidays from the 19 th of December through to the 5 th of January 2017, in the districts and city of Xai-Xai as done in the previous years. The principal objectives of this campaign are; disclosure of information and promotion of health messages to the mobile population and communities affected by immigration during this period of high migration. Reinforce activities of tracking and testing of TB and HIV in the community through home based visits. Promotion of sexual and reproductive health emphasizing on anticonception methods like condoms, DIU and pills. 16 R e p o r t f o r T C E C o m m u n i t y T e s t i n g G a z a