Place holder for PhotoOVERCOMING BARRIERS

TO ACCESS:Experiences from the

Call to Action Uganda Program

June 17, 2010

Joanna RobinsonElizabeth Glaser Pediatric AIDS Foundation

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Uganda PMTCT Cascade Results(January 1, 2000 – March 31, 2010)

* Cumulative cascade includes data from EGPAF’s privately-funded PMTCT activities in Uganda, initiated in 2000. USAID Call to Action funding in Uganda started in October ‘02.

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2,120,1461,979,270

1,649,605 1,614,265

107,508 127,019 104,803 58,227

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Barriers to Access of PMTCT

• Cultural, social, economic and other barriers impede women's access to PMTCT services at key health care entry points

• In many countries, barriers include:

- Low status of women

- Poverty

- Limited access to transport to health services

- Stigma and discrimination

- Non-disclosure of HIV status to women's sexual partners

- Health services that are not ‘user-friendly’

- Lack of community support

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Strategies Employed to Overcome Barriers to Access

• Instituting Quality Improvement efforts at the clinic level

• Integration of PMTCT, C&T into Reproductive & Child Health services

• Involvement of PLHIV in HIV prevention, care and treatment as part of a comprehensive care model

• Working with communities and families to optimize access to a broad network of services beyond scope of the PMTCT project

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Involvement of PLHIV• Family Support Groups (FSGs) introduced to CTA Uganda in

2005

• Goal: To provide HIV-related palliative care to HIV-positive mothers, fathers and children and to assist families to make informed reproductive health choices to prevent MTCT• Over 4,000 clients served through Uganda FSGs

• Provision of information and emotional support through FSGs helped to:- Reduce stigma- Dispel myths and misconceptions about HIV- Create empowerment through peer support

• Data from internal quantitative analysis of PSS (2005) showed higher uptake of individual services among those women who received PSS services through FSGs

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Peer Educators• Peer educator program developed in 2007,

introduced at sites implementing FSGs

• Peer educators selected from among HIV-positive parents identified during PMTCT

• Provision of formal training strengthened peer educator strategy by expanding assigned roles

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PEER EDUCATORS AFTER A TRAINING

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Task Sharing with Established HCWs • Peer educators stationed at ANC clinic and other key

entry points

• Allows for sharing of tasks between established HCW and lay providers, helping to reduce client waiting times at clinics

• Integrated HIV care roles include:- Clerical duties- Peer counseling- Distribution of Basic Care Packages- Assisting patient flow

• Home-based care provided by joint HCW-peer educator teams assisted in disclosure, strengthened linkages between community and health facility by involving PLHIV in patient care

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Working in Partnership with Communities

• Through community dialogue, Foundation outreach teams lead efforts to inform and educate communities about available HIV prevention, care and treatment services for children and families

• Local drama shows and electronic/print media used to disseminate both prevention and stigma reduction messages

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Psychosocial Support for Children • Children’s groups established to support children of

HIV-positive mothers attending health facilities

• Goal: To provide HIV-infected and affected children a chance to receive a “quality life” while meeting their psychological, social, spiritual, and physical needs

• Established at 4 referral hospitals, then rolled out to 19 support groups with active membership of over 1,000 children

• EGPAF’s experiences in setting up and running PSS services for HIV-infected children documented and disseminated in publication “A Guide on How To Start and Implement Ariel Children’s Clubs”

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Children’s Groups• Activities emphasize: stigma reduction, disclosure,

adherence to medication and positive living while building peer support

• Referral networks to other community-based service providers help families access other “wrap around” services

• Parents and caregivers are trained in long term care for chronically ill children

• Holiday children’s camps focused on development of life skills, prevention with positives and improved adherence to ART

• Groups serve as advocacy channels for children

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ARIEL CLUB CHILDREN SHARING MESSAGES ABOUT HIV THROUGH TRADITIONAL DANCE

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Male Partner Participation

• 100% coverage of HCT for pregnant women and comprehensive HIV care for HIV-positive women and their families is hampered by lack of male involvement

• “Male friendly" interventions include:

– Allowing pregnant mothers with male partners to receive ANC service priority

– Sending personalized invitations home for men to attend ANC with their partners

– Use of male peer educators to assist in couple counseling and disclosure

• Number of male partners tested for HIV increased from 3,577 in 2005 to over 29,000 in 2009

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Lessons Learned

• Approaches that reach into communities and address both the physical and psychosocial needs of individuals are a necessary component for successful implementation of PMTCT programs

• Integration of psychosocial support for families into PMTCT and pediatric ART programs introduced a new standard of care that has enhanced clinical programs

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Lessons Learned

“Every Child Deserves A Lifetime”

A Family Care Approach Ensures a Healthy Family

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EGPAF Uganda Team

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Acknowledgements

• Elizabeth Glaser Pediatric AIDS Foundation staff in Uganda, Regional, and USA

• Uganda Ministry of Health, ACP, RH, Nutrition, UAC, MOLG

• Partner Organizations incl. but not limited to: JCRC, SCMS, AHF/Uganda Cares, URC-NULIFE & HCI, IBFAN, GAIN, Baylor Ug, ANECCA, AIC, MJAP, PSI/PACE, HIPS, UMEMS, MEEPP, MUJHU, JSI, ICOBI, HIVQual, CRS, AIDS Relief, World Vision, Abbott Fund, CHAI, The UN agencies UNICEF, WHO

• All the clients who have entrusted their care to us

THANK YOUDISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.