CARE AND SUPPORT FOR THE CHRONICALLY ILL ( TRAINING OUTREACH EVENTS IN JANUARY 2014)
During this reporting period, HCBC program beneficiaries were brought together in seven outreach training events with the aim of imparting information, knowledge and skills for positive living geared towards improving and sustaining quality healthy and productive lives. Participants in these events were mobilized by the community health workers while facilitation of the sessions were done by the Community Health extension workers. Facilitators disseminated a content based on the time table developed by WADADIA as guided by the minimum package for outreach training activities. Topics covered included; Basic facts about HIV and AIDS, positive living disclosure, adherence to drugs, prevention of other diseases, HIV and STIs, condom use, Nutrition and referral and linkages. Facilitators ensured quality delivery of the content by employing several facilitation techniques that made the sessions more lively and participatory. These included mini lectures, group and plenary discussions, role plays, demonstrations and use of energizers.
In their proceedings, the facilitators together with the program staffs attending the sessions took participants through climate setting activities which involved introductions, expectations, program overview and session objectives.
Through brainstorming and plenary discussions led by facilitators, participants in these events were taken through basic fact about HIV and AIDS. Definitions of terms were done by participants assisted by the facilitators. It was evident that most of the participants in these sessions were aware of some of the terms and names in HIV and AIDS management and prevention. They were able to explain the meaning and concept of Prevention With Positives (PWP), Under PWP, participants through their facilitators were able to learn the importance of PWP as a concept with the strategy of preventing new HIV infections and re infections. They were informed about the 13 messages that are required to be understood by all the PLHIVs. They also learnt that they had a major role to play in prevention of the spread of HIV among the members of the society. Other issues discussed in this topic were myths and misconceptions and values and believes that contribute to the spread of HIV. Also covered were modes of transmission and prevention which involved condom demonstrations for both the female and male condoms. Facilitators and the mobilizer CHWs used the opportunity to share out the condoms for participants who were willing to carry some for use.
Definition of Prevention of Mother To Child Transmission was also done and explanation of the concept done by the facilitators who helped the participants understand that PLHIVs especially couples have a major role to play in PMTCT by ensuring that they use the information gained to prevent new infections to the infants and the unborn babies. They were also taken through advantages of PMTCT to the child, the couple, the family and the entire community. While discussing discordance, it was evident that this was a condition that community members understood in different perspectives coupled with myths and misconception as well as rumours. In all these events, most participants thought that individuals with blood group “O” were resistant to HIV infections. The discussions on discordance contributed greatly to participants asking more and more questions about effectiveness of condoms and effectiveness of the Rapid Anti Body HIV testing devices. Several individuals in these outreaches also wanted to know more about Post Exposure Prophylaxis. Disclosure in these events was discussed at length where in some of the events, through guidance of the facilitators; participants were able to do role playing depicting the same. Participants were able to discuss importance and benefits of disclosure and how it can be done through the role plays and group discussions.
Participants in these sessions were also taken through discussions on the importance of Adherence to drugs. Definitions were done through brainstorming led by the facilitators. Participants learnt that adherence involves medication and medical advice. It was explained that drug Adherence was the commitment made by a patient to take the drugs as prescribed. They were able to learn that adherence requires individuals to have self discipline and be able to strive to endure the initial side effects of the ARVs. Participants in these outreach events were in agreement with the facilitators that adherence to ARVs requires a change in the lifestyle including keeping away from alcohol and cigarettes.
Nutrition in positive living was discussed in these events where participants learnt that it involves eating the right foods in the right quantities to ensure good health. The facilitators were able to help the participant in distinguishing and drawing the differences between a balanced diet and nutrition.
The events could not go without discussions on referrals and linkages, through plenary discussions, participants were able to explore the advantages and importance of the referral linkages and systems. They were informed about the kind of services that may be found in different facilities and institutions as well as organisations. In one of the PLHIV outreach in Mumias, a client was identified who had difficulty of disclosing his status and was referred to a support group as he had not joined any.
These sessions in their conclusions, the facilitator ensured that all the participants had gained something to go home with. To ensure this, the facilitators conducted general evaluation by revisiting topics covered with quizzes that participants answered in plenary sessions.
PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV. PMTCT TRAINING OUTRECH EVENTS JANUARY 2014
The training outreach events for pregnant mothers in the month of January 2014 were conducted in all the three Districts of Mumias, Matungu and Khwisero. The main objective of these events, was to empower and equip pregnant mothers with information and skills, that can help them make use of ANC services in an effort aimed at preventing new HIV infections to the new born babies. The activities were conducted on 22nd, 23rd, and 24th of January 2014. The sessions were conducted by facility CHEWs and nurses trained in PMTCT. The content disseminated was based on the programme timetable developed by WADADIA in line with the minimum package for PMTCT training outreach activities. Clients in these sessions were taken through climate setting activities which included introductions, sharing of expectations, setting of guiding norms and appointing of group leaders. Besides these, the staffs used this sessions to provide session objectives and organisational overview to the participants. The topics disseminated included basic facts about HIV and AIDS, introduction to PMTCT, effective condom use and disposal, introduction to Ante-natal Care and importance of HIV testing. Benefits of family planning were also discussed in these sessions. Referrals and linkages were discussed in these sessions to help participants understand the importance of the links between the communities and the health facilities and how they can be utilised to ensure easy access to healthcare services.
Basic facts about HIV and AIDS were the first topic covered in these sessions. The topic was used to help participants understand why the session on PMTCT was held as well as bringing the understanding of why PMTCT was initiated as an intervention to curb HIV infections. Participants were taken through definitions and meaning in full of HIV and AIDS, the modes of transmission, how to prevent HIV infections. Care and treatment services and how to get them were also discussed in these events. Facilitators in these events allowed questions which they also responded to. Besides the facts, these sessions could not go without facilitators dealing with common myths and misconceptions on HIV and AIDS that came up from participants.
Under the topic on introduction to PMTCT, participants in these events were guided through plenary discussions on Mother To Child Transmission. They explored through discussions and brainstorming on how and when infection of the virus occurs to the baby. Through these efforts, participants in these events learnt that HIV transmission from the mother to the baby may occur during pregnancy, during labour, during delivery and even when breastfeeding. Facilitators therefore took participants through group and plenary discussions where they explored and identified factors that contribute to HIV infections among the new born babies. The sessions also focused on how prevention of HIV can be done by the women and how their families and spouses can be involved. It emerged in these sessions that men were still playing a major role as the main decision makers in matter of reproductive health. It was through this observation that facilitators chose to guide the pregnant women through plenary discussions on how best to go about in involving their spouses in PMTCT. It was interesting to note that cultural values and beliefs still have effects and are part of factors that hinder effective response to reproductive health problems of women as well as transmission of HIV. Facilitators ensured that participants were equipped with information through summarizing the topic with minimal lectures that provided participants with facts.
Introduction to ANC was discussed in these events where facilitators guided participants in discussing the kind of services that are found and offered in ANC clinics. With the help of the facilitators, participants in these events learnt that ante-natal care was the medical nursing care for pregnant women during their course of pregnancy up to the time they give birth.
The number and importance of ANC visits were also discussed in these sessions where facilitators used plenary discussions that allowed participants to brainstorm and come up with minimum number of ANC visits required by pregnant women up to completion of their course of pregnancy. It was evident that some women in these events could not figure out the total number of visits that should be made by pregnant women as well as even when to begin the visits.
With the guide of the facilitators participants were able to brainstorm and explore the benefits of HIV testing to individuals, pregnant women, babies and couples as well as to the entire family. Participants were able to learn about types and approaches of HIV testing in Kenya. These were Provider Initiated Testing and Counselling and Client Initiated Counselling and Testing. Under these two approaches, participants were able to brainstorm the types of testing and counselling such as standalone VCT, Mobile VCT and Home/ door to door testing and counselling.
On referral and linkages, participants were informed of the existence the community health workers that act as the main link between various institutions such as hospitals that work as referral centres for clients and patients and other organisations a well as microfinance institutions. Mobilizer CHWs in the outreach activities were encouraged to consistently keep sharing the information acquired and to always make use of the referral systems available within their districts with their clients during home visits while the clients were encouraged not to hesitate in case they need assistance from the CHWs.
MEN INVOLVEMENT IN PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV – JANUARY 2014 OUTREACH
Fifteen men of Bukaya location were brought together in an event held at Bukaya health centre. The activity began at 9:30am with a prayer by one of the participants. This was followed by welcome remarks from the host CHW Mr Alfred Omolo. He thereafter invited the WADADIA field officer who introduced herself and the attaché that had accompanied her to this venue. The staff used the opportunity to give an overview of WADADIA and the programs being implemented under the Kenya Red Cross Society’s Global fund round 10 HIV project. The staff without wasting time welcomed the facilitator who proceeded with climate setting activities. He began by asking each individual to introduce the person seated next to them as a warm session of getting to know the persons seated next to them.
This exercise allowed participants to find out who was seating next to them. It was interesting as it made all the participants comfortable and that was the onset of all the discussions from the word go. In their introduction, participants were required to state their names, where they reside, their marital status, including if polygamous and to confirm if their partners had also participated in the pregnant women’s outreach held at the same venue on 23rd Jan 2013. Also done as part of climate setting activity was for the facilitator to determine the participants’ expectations of this event. Participants were also allowed to nominate a leader who doubled up as the timekeeper. Climate setting was finalised by formulation of guiding norms and nomination of the timekeeper and the chairman.
Prior to embarking on the main topic of the day, participants were first of all taken through basic definitions and basic information of HIV and AIDS. These included manning of HIV and AIDS in full, modes of transmission, prevention and factors that lead to the spread of HIV among couples. The facilitator while discussing prevention of HIV through sexual contact, guided participants in understanding the nine steps in proper condom use through a condom demonstration for both the male and female condoms.
Thereafter, this was followed by introduction to PMTCT. In this topic, the facilitator helped participants in defining and ensuring that they understood the meaning of the acronym and the entire concept as a strategy in prevention of new HIV infections. Participants were able to learn that PMTCT meant Prevention of Mother To Child Transmission of HIV virus. Through group work activities and plenary discussions, participants were led through exploration of the role of couples in prevention of HIV infections to babies, the role of men in prevention of HIV to both the mothers and the babies. Also discussed under PMTCT was what is usually offered in PMTCT clinic and the kind of services and interventions that PLHIV mothers can access during their course of pregnancy.
Introduction to ANC was also discussed in this event. Participants through brainstorming and discussions guided by the facilitator were able to discuss where the services can be found, benefits of the services to the mother, the family and the couple. The 15 participants in these sessions also had a chance to be taken through the mother baby booklet. Most of them confessed not to have taken time to go through the booklet and therefore had no idea if the booklet has messages to the entire family. Those who confirmed to have gone through it confessed to have only checked at the section that indicated the HIV test results for their spouses. That again happens in absence of their spouses. Through these discussions, it was observed that majority of men have other sexual partners when their wives are pregnant. Participants were also informed about the number of visits required for a mother to complete the ANC clinic visits during her course of pregnancy up to the time of delivery.
Importance of HIV testing was also discussed in this event and participants with guidance of the facilitator were able to brainstorm and come up with benefit of HTC to the mother, the baby, her spouse and the entire family as well as the whole community.
The last to be covered in this outreach event was referrals and linkages. Participants were taken through the meaning of the term by the facilitator. They were also informed about the linkage between the community and the health facilities. They were able to learn the role of CHWs in linking up clients in the community and the facilities. Participants were allowed time to ask questions. Some of the questions asked were: What the is the difference between P.E.P and E-Pill?, Why do PLHIVs take Septrin?, Why are female condoms too expensive? Can men use pills for family planning? Why is it that some women when pregnant they tent to hate their husbands?
These questions were responded to by the facilitator by involving participants in brainstorming and discussing possible answers before his clarification. The day’s session came to an end with brief review of the expectations to determine if they were achieved. Participants were then issued with Kata shauri brochures and condoms for those who wanted to carry some.