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 Islamic Medical Association of Uganda CDC Uganda CDC Uganda

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 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 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 Intervention Model using faith based organisations

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.

Status 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 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 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 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 Cont…..

( 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

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 leaders quote the following verse 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 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 Mobilization Cont…

(5) Support Supervision Monthly Community Educators’ meetings Quarterly Community Leaders’ meetings On-site supervision by trainers

(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 …

Acknowledgements Community members Community leaders Faith based organisations IMAU staff CDC UNAIDS/UNICEF