HIV /Tuberculosis in the community PASADA Experience Dr Dorothy Mandwa

PASADA Pastoral Activities and Services for people with HIV / AIDS Dar es Salaam Archdiocese

Mission Statement Responding to the call of faith, PASADA strives to provide and maintain quality, caring and compassionate services and support people affected by HIV /AIDS in the Archdiocese of Dar es Salaam, with particular attention to the poorest and most needy, through a holistic approach and with a special emphasis on the values of justice and solidarity.

Main Activities of PASADA Voluntary Counselling and Testing Medical Care for HIV Pos adults and children PMTCT programme in all the VCT centres and ARV programme in initial stage. Home Based Care for patients too sick to attend Psycho-social support for orphans and vulnerable children Community Education in Schools, parishes and for community groups using ‘Stepping stones’- Kivuko. Explain – if necessary, that there is a MOH /NACP programme to introduce ARVs to 400,000 people in TZ over the next 5 years. – supported by the Clinton Foundation. PASADA has been included in the talks and has been visited on several occasions by their consultants. It seems that PASADA is in a good situation regarding the standard of Lab, Counsellors, medical staff etc to give ARVS. To show our capacity we have started to give ARVs and have so far 12 patients on them ( adults and children) these are privately funded – so that Clinton Foundation programme can take over before one year has passed.

Support groups at PASADA

HBC nurses are given medicines from PASADA – with strict control

Development of Home Based care 1992 – one of the first activities- few people visiting the homes of PLWA Numbers increased and logistically difficult to reach many patients 1998 Sought the help of volunteers – Community Health Educators CHEs working with another diocesan progamme – DACHEP. Direct visiting from PASADA continued.

Lucy in her poor home

Home Care visit by Clinical Officer

Support for volunteers They are visited monthly by PASADA HBC nurses. Report patient records to PASADA on a monthly basis Meet every three months for support, updating and renewal. Not paid- get bus fares and occasional non monetary items.

2001 To improve the quality of HBC three staff members of PASADA did 6 week course in Palliative Care. PASADA initiated decentralisation of services to the dispensaries of the Archdiocese. Starting with 8 dispensaries

Staff at Kawe Dispensary

As PASADA grew Challenges Socio- economic To reach more patients at home with quality HBC To make early diagnosis of TB To improve networking with other service providers. To incorporate PMTCT into the services.

PASADA and Tuberculosis. Patients were referred to Temeke, Ilala or to Mwananyamala Many were lost. PASADA was not recognised as a TB centre Poor recording of TB data Many TB patients on HBC – not under good supervision.

Process of Change National TB personel approached PASADA – discussions on what we were doing. PASADA laboratory services improved and staff trained in TB, recognised as a TB centre Cooperation with Temeke District Hospital in training and management Because the Home Based Care was well established. PASADA used to start TB Rx using HBC services.

Current State of TB /HIV Activities – PASADA – since February 2003. 36 Patients have been diagnosed, registered and are on treatment Of these 36 patients 5 are on HBC Another 185 HIV + people attending PASADA are on TB Rx at other centres So a total of 221 patients registered at PASADA are on TB Rx Of these 87 are on HBC programme 47 of these are under the HBC trained nurses and 40 visited by CHEs

Lessons Learned Commitment to decentralization Setting up satellite PASADA centres is difficult- strict supervision is necessary Importance of integration of TB services in HIV / care otherwise TB patients are lost Close Co-operation of Government TB services with NGOs necessary TB Rx with HBC is very important because HBC ‘hides’ the TB patients

Future-to develop an integrated community based HIV – TB programme Train HCW including HBC nurses and VCT counsellors to Dx TB & improve facilities at dispensaries Establish DOTS centres at 8 dispensaries initially – later to all 18, under the supervision of PASADA Train CHEs in TB Dx and in DOTS Encourage the TB centres to include HIV testing in their activities – two way referrals PASADA care and support centre to provide ARVs- under the new MOH / NACP plan