Community Mobilization Community Mobilization Intervention Model for Intervention Model for

Prevention of Mother to Prevention of Mother to Child HIV Transmission Child HIV Transmission

(PMTCT) and Antiretroviral (PMTCT) and Antiretroviral TreatmentTreatment

in Kampala, Uganda in Kampala, Uganda Karama S., Kagimu M., Ezati E., Bunnell,R .Karama S., Kagimu M., Ezati E., Bunnell,R .

Islamic Medical Association of UgandaIslamic Medical Association of Uganda

CDC UgandaCDC Uganda

Background of PMTCT Background of PMTCT in Ugandain Uganda

• Annually about 30,000 children are getting HIV infected through mother-to-child transmission in Uganda.

• 6.5% HIV prevalence among women attending ANC

• 1n 2000 - a pilot programme to reduce MTCT was initiated by the Uganda government in collaboration with UNAIDS, UNICEF, WHO and other partners.

• The programme targets women attending ANC

• Todate 48 PMTCT centers are functional in 31 of the 56 districts of Uganda.

• Despite the intervention, utilisation of PMTCT services has been poor mainly due to inadequate education & sensitisation of communities.

Background of PMTCT Background of PMTCT in Uganda Cont…in Uganda Cont…

• Goal:

To mobilise the community to utilise PMTCT services through community education.

• Intervention:

Formative Research,

Curriculum Development,

Training of trainers & community educators, and

Community education & Mobilization

Community Mobilisation Community Mobilisation Intervention Model using faith Intervention Model using faith

based organisationsbased organisations

Community Mobilisation Community Mobilisation Intervention Model using faith Intervention Model using faith

based organisations Cont..based organisations Cont..

Intervention strategy:• Use Community Action for AIDS Prevention network.

Uses religious leaders of different faiths and local council leaders.

• Use of key religious teachings to bring out messages

• Community education and mobilisation. Trained community educators Sermons in churches and mosques; Mini lectures, Group talks and home visits. radios, televisions, newsletters, T-shirts and use of referral cards

with messages.

Status of Project ImplementationStatus of Project Implementation

(a) Overall objective: to obtain baseline data on community knowledge and beliefs related to PMTCT.

(b) Method: 12 Focus Group discussions with community members and leaders

(c) Data used to develop training curriculum for community leaders and members

1. Formative Research

Formative Research FindingsFormative Research Findings

• Low knowledge on PMTCT, ARVs & Discordance

• Few people knew their sero-status or that of partners

• Low utilisation of PMTCT and VCT services due to lack of information & stigma

• Inadequate male involvement

• Poor service quality at ANC/PMTCT sites

• Community education through sermons, group discussions & homevisits recommended.

(2) Curriculum Development(2) Curriculum Development

Curriculum for Community education developed

Main topics:•PMTCT, ARV, ANC, VCT •Men’s involvement•Behavior change communication skills•Community mobilization using sermons, group discussions and home visits

(3) Training(3) Training • 25 Trainers trained to train community leaders/educators

• 150 community leaders trained to train community educators• 38 Local Councils• 27 Catholics• 29 Anglicans• 29 Muslims• 27 Independent churches• Each community leader had 4 volunteers: 2 females and 2 Males

• 600 volunteers were recruited and trained as community educators

Trained in 5 day workshops

• Baseline assessment of knowledge, attitudes and behaviour of the educators indicated

• Low knowledge on meaning of

• HIV negative result,

• Discordancy,

• Vertical transmission and

• Infant feeding

• Knowledge increased• Baseline average mark 45%• Post-training average mark 76%

(3) Training of community educators(3) Training of community educators Cont….. Cont…..

((4) Community Education and 4) Community Education and MobilizationMobilization

November 2002 to June 2003:

Sermons - 2,914 Mini-lectures - 4,910 Group discussions 4,498 Home visits - 11,569 Number of People educated Men - 159,363 Women - 174,704

Clients reported to PMTCT sites with referral cards - 272

1.       Surat Hujrat 49:11 “O ye who believe! Let not some men among you laugh at others; it may be that the latter are better than the former. Nor let some women laugh at others; it may be that the latter are better than the former. Nor defame, nor be sarcastic to each other, nor call each other by (offensive) nicknames…”.

In relation to stigma the Muslim In relation to stigma the Muslim leaders quote the following verse leaders quote the following verse from the Qur’an:from the Qur’an:

Radio programmes - 25

TV programmes - 4

Newsletters - 7,500

T-shirts - 800

(Message: Protect Children from AIDS )

((4) Community Education and 4) Community Education and Mobilization Cont…Mobilization Cont…

Referral cards with messages

It is a sign of love and responsibility when a husband accompanies his wife to attend the antenatal clinic.

((4) Community Education and 4) Community Education and Mobilization Cont…Mobilization Cont…

(5) Support Supervision(5) Support Supervision

•Monthly Community Educators’ meetings

•Quarterly Community Leaders’ meetings

•On-site supervision by trainers

(6) Lessons learnt(6) Lessons learnt

• There was a low level of knowledge on PMTCT issues and services

• High demand for PMTCT activities in the communities

• Strategy of using religious leaders increases coverage

Community mobilization for PMTCT through religious and local government leaders is feasible and practical

Motivation of community educators (small financial, T-shirts, certificates and badges) encourages them.

“This project has united people of different faiths to work together to fight a common enemy” – community leader

“I like IMAU’s transparency and their regular supervision,” – community educator

(6) Lessons learnt Cont(6) Lessons learnt Cont……

AcknowledgementsAcknowledgements

•Community members

•Community leaders

•Faith based organisations

•IMAU staff

•CDC

•UNAIDS/UNICEF