Community Mobilization Intervention Model for Prevention of Mother to Child HIV Transmission (PMTCT) and Antiretroviral Treatment in Kampala, Uganda

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Community Mobilization Intervention Model for
Prevention of Mother to Child HIV Transmission
(PMTCT) and Antiretroviral Treatment in Kampala,
Uganda

• Karama S., Kagimu M., Ezati E., Bunnell,R .
• Islamic Medical Association of Uganda
• CDC Uganda

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Background of PMTCT in 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

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Background of PMTCT in Uganda Cont

• 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.

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Community Mobilisation Intervention Model using
faith based organisations

• 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

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Community Mobilisation Intervention Model using
faith 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.

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Status of Project Implementation
1. Formative Research

• (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

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Formative 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.

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(2) Curriculum Development

• Curriculum for Community education developed

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

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(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

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(3) Training of community educators
Cont..

• 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

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(4) Community Education and Mobilization
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

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In relation to stigma the Muslim leaders quote
the following verse from the Quran
1.       Surat Hujrat 4911 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.
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(4) Community Education and Mobilization Cont

• Radio programmes - 25
• TV programmes - 4
• Newsletters - 7,500
• T-shirts - 800
• (Message Protect Children from AIDS )

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(4) Community Education and 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.

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(5) Support Supervision

• Monthly Community Educators meetings

• Quarterly Community Leaders meetings

• On-site supervision by trainers

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(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

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(6) Lessons learnt Cont

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

I like IMAUs transparency and their regular
supervision, community educator

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

This project has united people of different
faiths to work together to fight a common enemy
community leader
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• Acknowledgements
• Community members
• Community leaders
• Faith based organisations
• IMAU staff
• CDC
• UNAIDS/UNICEF

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