1. HIV /Tuberculosis in the community
PASADA
Experience
Dr Dorothy Mandwa

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

4. 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.

5. 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.

6. Support groups at PASADA

7. HBC nurses are given medicines from PASADA – with strict control

8. 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.

9. Lucy in her poor home

10. Home Care visit by Clinical Officer

11. 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.

12. 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

13. Staff at Kawe Dispensary

14. 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.

15. 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.

16. 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.

17. 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

18. 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

19. 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