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Community Based Groups PMTCT in Rural Malawi

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Matt Hackworth, Director of External Relations at IMA World Health discusses how IMA engages faith leaders and community-based leaders to educate people about HIV in Malawi at the CCIH 2018 Conference.

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Community Based Groups PMTCT in Rural Malawi

  1. 1. The Power of Partnerships: Leveraging Community-Based Groups to Increase the Prevention of Mother-to- Child Transmission of HIV in Rural Malawi
  3. 3. AIDSFree Project Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) PMTCT Activity Dedza District, Malawi May-November 2017
  4. 4. About AIDSFree • The Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project aims to improve the quality and effectiveness of high-impact, evidence-based HIV and AIDS interventions in order to meet country-specific goals and objectives • Funded by USAID and implemented by a consortium of 8 partners (JSI, Abt Associates Inc., Elizabeth Glaser Pediatric AIDS Foundation, EnCompass LLC, IMA World Health, the International HIV/AIDS Alliance, Jhpiego Corporation, and PATH) • Works globally, mostly in Sub Saharan Africa • IMA World Health’s role on the project is faith based health systems strengthening, community engagement and CSO capacity building • Period of performance: July 22, 2014 – July 21, 2019
  5. 5. Purpose : WHAT Technical Assistance to build the technical competence and organizational capacity of Civil Society Organizations’ (MANERELA+) in community mobilization in PMTCT through faith engagement Objectives : WHY • Strengthen the capacity of MANERELA+ and its network in community mobilization for PMTCT • Increase community knowledge of PMTCT services • Increase demand, uptake and retention of mothers/baby pairs to PMTCT services Approach : HOW Partnership Religious leaders
  6. 6. Our FBO Partners MANERELA+ (Malawi chapter of INERELA+) CHAM (Christian Health Association of Malawi) Community Linkages Interfaith AIDS Alliance (Dedza) Mentor Moms and Peer Educators (participants in a Global Fund project also underway in Dedza)
  7. 7. Context FRAMEWORK: UNAIDS 90-90-90 Goals FIRST: 90% of HIV+ people know their status NEXT: 90% of these receive ART THEN : 90% of these achieve viral suppression NEED: 90% of HIV+ pregnant women in Malawi go on ART … BUT… gaps in identifying and in retaining mother-baby pairs (50% retention, compared to 85% national target). OPPORTUNITY: Malawi is 90% Christian. Religious leaders have considerable social capital.
  8. 8. 4-Pronged Strategy • 1. Engage local health facilities to receive referrals and share PMTCT service delivery data • 2. Train religious leaders as PMTCT advocates and mobilizers • 3. Facilitate coordination with other community- based actors • 4. Provide monthly supervision & group process for RL cadre
  9. 9. 1. Engage Health Facilities • Two faith-based HFs in the CHAM network (Mua, Mtendere) were directly engaged • Two government facilities (Lobi, Mtakataka) also provided data
  10. 10. 2. Train religious leaders as PMTCT champions • Local interfaith AIDS group identified 20 religious leaders to participate: – 10 Christian, 10 Muslim – 10 male, 10 female – Range of ages
  11. 11. • 3-day workshop conducted in April : – Charging religious leaders as PMTCT advocates & mobilizers (MANERELA+) – PMTCT technical sessions (EGPAF, with Assistant PMTCT Coordinator, Dedza District) – Community coordination visit – “Framework for Dialogue between Religious Leaders and People living with HIV” (MANERELA+) – “10 Key PMTCT Messages for Religious Leaders” (facilitated by IMA) – M&E for RL participants and health facilities (CHAM)
  12. 12. TOPICS included: Why data matter What the project will track What the “PMTCT Champions” will record What we hope to learn M&E Session for RLs and HFs
  13. 13. Community Meeting, Mtendere • Religious leader cadre • Health facility management and staff • Health Advisory Committee • “Mentor moms” • “Peer educators”
  14. 14. “10 Key Messages” • S = Safer Practices 1. With PMTCT, an HIV-positive woman can give birth to an HIV-free baby. 2. HIV-positive pregnant women need the support of their male partners and family members to encourage them in PMTCT. 3. Good nutrition is important for all pregnant mothers, even more so if HIV- positive. 4. Exclusive breastfeeding for 6 months is the best plan for all babies, including babies of HIV-positive mothers who stay on ARVs. 5. Importance of family planning.
  15. 15. “10 Key Messages” • A = Access and Availability 6. All HIV-positive individuals should begin treatment as advised - and STAY on treatment faithfully. This is a very important intervention for prevention of mother-to-child transmission of HIV. • V = (Voluntary) HIV Testing and Counseling/Self- Testing 7. All pregnant women should go to ANC and get tested for HIV. Their male partners should be tested as well. 8. Exposed infants should be tested for HIV.
  16. 16. “10 Key Messages” • E = Empowerment 9. HIV is a disease, not a curse. Stigma and discrimination must end. 10. An AIDS-free generation is possible if we work together with other community actors. RELIGIOUS LEADERS HAVE A VERY IMPORTANT ROLE TO PLAY!
  17. 17. Achievements • Mobilization of diverse group of RLs who utilized a range of activities for outreach • Male involvement • Coordination with health facilities and community groups • Draft PMTCT Addendum to SAVE Toolkit • Sustainability plans
  18. 18. Data, May-Nov 2017 • Community level data collected through RL activity reports and referral tracking >11,000 people reached with HIV messages • Facility level data collected in registers and analyzed with facility staff monthly > 2,700 women tested during antenatal care (ANC) with 42 (1.52%) positives
  19. 19. 1282 1515 546 366 534 504 1999 1914 850 479 677 667 0 500 1000 1500 2000 2500 June July August September October November #ofPeopleReached Month COMMUNITY DATA: OVERALL SUMMARY; # of People Reached Jun - Nov 2017, n = 11,333 Male Female Linear (Male) Linear (Female)
  20. 20. Challenges! • Brief implementation period • Participant recruitment process • Small budget • Tracking referrals
  21. 21. Some Project Take-Aways … • Religious leaders are effective educators and mobilizers for HIV/AIDS activities • Relating to congregations and to couples, RLs can encourage male engagement in PMTCT • The RL who takes on such a role also benefits, gaining skills, knowledge, community recognition • Mechanisms for ongoing support and monitoring are important to address issues and sustain momentum
  22. 22. Some Project Take-Aways … • Linkages are can provide benefits at many levels. – Community actors may not know what others are doing and thus miss opportunities to coordinate, reinforce, learn from each other, reduce duplication of effort. • Even small-scale, short-term efforts can build enough interest and momentum to present opportunities for sustainability.
  23. 23. Thank You!