Road towards HIV free society

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The first discovery of the HIV virus brought about fear, stigmatization, untimely IMG_20160820_110734deaths and suspense in the community. Since then interventions to combat the spread and multiplication of the virus have been put in place. Most of this efforts have borne great positive results. WADADIA has also played and still plays a major role in implementing this interventions. We have journeyed along visionary partners to see a result of a HIV free society. Although we have not fully achieved this vision but we are closer to the goal. Gone are the days when people suffering from HIV virus were stigmatized. It is such joy to know that you have someone to lean on regardless of your situation. Among the interventions in combating the spread of the virus are prevention of mother to child transmission and support groups for people living with HIV virus. Support groups for the people living with HIV encourages them to embrace their status, lead a healthier life and also fit more comfortably in the society. Here is an excerpt of a support group for the adolescents.

 

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Wadadia peer educators participated in WORLD TB day

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WADADIA through the peer educators continued with peer education sessions with their peers in various mapped hotspots. Both individual and group sessions were conducted. The 19 peer educators conducted 76 group sessions that were held during this reporting period. Through these sessions, 266 peers were reached with information on STIs, HIV, Condom use, HIV testing, general contraceptives and family planning. The peers in these sessions were issued with IEC materials and condoms. 432 condoms and 268 TB brochures were also issued through these sessions. 28 peers and their clients were reffered for HTC services in various testing centers.

Besides the usual peer education activities,    Wadadia peer educators participated in WORLD TB day, the members converged at Mumias Dispensary where they gave a talk on TB, the members taught the group on why TB is a major problem that affects many people, and TB is an infectious disease caused by bacteria-tiny germs that can be spread through the air. The common form of TB usually affects the lungs and can affect other parts of the body except nails, hair and teeth, if a person who is sick with TB coughs or sneezes and a healthy person breathes in the germs they could get infected. They also outlined some of the signs and symptoms of TB such as  persistent cough that lasts 2 weeks or more and do not get better with ordinary treatment, coughing of blood stained sputum, night sweats, weight loss, fever or chest pains, if a person has these symptoms it means he /she have TB and is advised to seek treatment immediately or else they might be at risk

Having TB doesn’t mean that one have AIDS, TB is preventable and curable for people who are HIV positive or HIV negative,

Wadadia peer educators during WORLD TB DAY at Mumias Dispensary, Nerea in the middle giving a health talk.

Wadadia peer educators during WORLD TB DAY at Mumias Dispensary, Nerea in the middle giving a health talk.

 

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Planned Activities April 2014

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With additional 26 new CHWs to the current 88 old CHWs, WADADIA began the new quarter with a plan to conduct 2,295 home visits for 2,295 PLHIVs. This was an expected additional target of 520 clients to the previous target of 1,775 beneficiaries receiving services from the organisation’s CHWs. The new 26 CHWs were also targeted for the Phase II HCBC training in the month of April 2014.

Under SDA 2.1 for PMTCT, WADADIA had 2 outreach activities planned targeting 38 pregnant women as well as one for Male involvement in PMTCT targeting 15men. Besides the outreach events, the organisation through CHWs had a target of tracking pregnant women and achieving

87 skilled deliveries during the month of April 2014.

Under leadership and governance, the organisation had a plan to conduct one monitoring visit for each of the three sub counties of program implementation, making a total of 3 monitoring visits for the month of April 2014. Three monthly progress review meetings for CHWs in all the three Sub counties were also planned for this reporting period. The organisation also aimed at compiling and submitting the April monthly report to the PR, through the North Rift regional office of the Kenya Red Cross Society.

HCBC Phase II training

On implementing the planned activities, all the 26 new CHWs were able to complete their Phase II HCBC training that was held at MUMCOP hall in Mumias town. The  training  was conducted with the aim of completing the 10 days HCBC curriculum as required by NASCOP. The trainees who had benefited from the first phase of training with one month field practice were evaluated and taken through this second phase training held at MUMCOP hall in Mumias town. The first day was for introduction overview, and review of HCBC field activities. The second and third day of the training was for Review of HCBC principles and components, Integration of HCBC in level one services, PWP concept and pillars as well as PWP messages. The third day also involved field visit preparations that were to be conducted on day 4 of the training. Day four was set aside for the field visit and day five saw participants present their field visit reports.  Work plans, way forward and closure were done on day five which was the last day of the training.

 

Home Visits

CHWs continued with home visits to their client with the aim providing HCBC services. The visits had several objectives among them was to assess the progress made since previous visits. They also aimed at updating care givers and their clients on nursing care skills. Besides that, CHWs addressed nutritional issues, adherence, safe water, prevention treatment and management of OIs as well as personal hygiene. Through the 2,056 home visits, CHWs reported to have reached 2,019 beneficiaries where 1,519 were females and 500 males. 85 clients did not receive the services in April 2014.  CHWs reported 1,964 clients to be on ARVs. The reports indicate more women to have been enrolled and received services on HCBC compared to the male clients. This is attributed to the fact that women in these communities are the most infected and even affected by the burden HIV. Besides that, men in these communities take long to cope with effects of HIV thus leading to delay in uptake of health care services both at community and facility level. Most men being bread winners in most families stay away at work which makes it difficult to be reached with services during home visits.

 

PLHIV Outreach Events

All the 3 planned outreach training events were held for 90 PLHIVs and care givers. In total theses were 22male and 68 females. The content disseminated was developed as provided in the minimum package manual for outreaches which included: Basic facts about HIV, a topic that involved definitions of HIV and AIDS, PWP and PMTCT and HTC.  Other topics covered were STIs which included types of common STIs and how to prevent the infections, condom use positive living, stigma reduction, opportunistic infections and how to prevent them was also covered, community and health facility linkages. To ensure the sessions were lively, participatory and interactive, the facilitators used various techniques of facilitation among them, mini lectures, questioning, role plays, skills demonstrations, group work and plenary discussions, brainstorming and energizers were also instrumental in delivery of the content to the 90 beneficiaries.

 

ANC/ PMTCT Initiatives

Tracking of pregnant women

Both old and new CHWs continued with enrolment and tracking of pregnant mothers for the purposes of supporting the mothers in accessing ANC services as well as PMTCT services for the HIV positive ones. Tracking of pregnant women also aimed at supporting and ensuring that all the pregnant mothers are equipped with information for healthy living of both the mothers and their unborn babies during the course of pregnancy. CHWs were also required to ensure that the mothers accessed health facilities for delivery by skilled health care providers. During this reporting period, tracking was done for 766 pregnant women with 131 deliveries being reported. 102 of these deliveries were facility deliveries while 29 were home deliveries. The home deliveries were attributed to cultural values, beliefs and practices. It was also noted that due to literacy levels and lack of support by their spouses due to cultural values and distance to facilities were causes to the reported home deliveries.  26 pregnant women among those being tracked were PLHIVs all on HCBC and PMTCT interventions. 5 of the 26 PMTCT mothers delivered in April 2014. One the five mothers delivered at home but the responsible CHW assisted her in accessing post natal care at a health facility within 72 hours.  24 teenagers of ages 16 to 19years were also reported to have delivered with 3 of them delivering at home. None of the teenage mothers were HIV positive by the time of delivery.

Stephen Ombikhwa, a CHEW with pregnant women in an outreach training event in Matungu Sub county

Stephen Ombikhwa, a CHEW with pregnant women in an outreach training event in Matungu Sub county

Through the PMTCT outreaches, 45 pregnant women and 16 men were reached with information on HIV ANC and PMTCT. These were two events for pregnant women and one other event organised for men involvement in PMTCT. Through these events, participants were issued with IEC materials on the importance of ANC clinics and family planning.

Under SDA 3.1 for Leadership and Governance, the organisation was able to conduct the 3 planned monitoring visits in the three Sub counties of program implementation. 18 PLHIVs and 9 ANC/MCH clients with 5 of them on PMTCT were reached through the visits. Under this same SDA, the organisation participated in the PR’s CSOs quarterly coordination progress review meeting held in Eldoret town at Boma Inn hotel for the entire north rift SRs. WADADIA was represented by the Program Assistant, the Accounts officer and one Field officer. The Community Health Workers’ monthly progress review meetings were conducted as planned. Except for Mumias with two meetings held, one meeting was held in each district making it a total of four meetings held as planned for the month.

Quality Improvement Training

The WADADIA program staff were privileged to participate in the Continuous Quality Improvement training held at the Boma Inn of Eldoret town. The training organized and supported by the KRCS’ Global fund management unit was conducted by IDEAL Public Health and Development Consultancy – (IPHDC) targeting the North rift SRs program staff. This was a three day training attended by the Program Assistant and the two field officers.

The training with the aim of equipping trainees with knowledge, skills and practices on Continuous Quality Improvement in HIV programming was successful as all participants were issued with certificates of participation. Action plan as well as action points were developed as way forward for the training for all the organisations. Following this, the staff were tasked with developing organisational action plan for implementation of the QI process.

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WADADIA CBO’S HCBC and PMTCT ACTIVITIES FOR FEBRUARY 2014

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In the month of February 2014, the organization had several activities planned for. Under Service Delivery Area 1.2, for care and support for the chronically ill, the organization had a plan to reach 1775 PLHIVs through home visits with HCBC services by the organisation’s 88 Community Health Workers. The services were planned with the aim of achieving 1,775 home visits for both the old and new clients. 9 PLHIV outreaches were also planned targeting 270 clients.
Under the organisation’s progress in this SDA, both old and new CHWs continued with provision of HCBC services through home visits targeting the PLHIVs as planned. They were able to conduct a total of 1,863 home visits for 1,754 PLHIVs in total. 77 old clients did not receive the services in the month of Feb 2014. Among those receiving the services were 41 new clients (26 females and 15 males) while the old clients were 1,713 (1,286 female and 427 male).
Besides the CHWs activities, the organisation was able to carry out 9 PLHIV training outreaches for 274 clients against the planed target of 270. Participants in these events were taken through sessions guided by the Minimum Package Guideline for PLHIV training outreach activities developed by the Kenya Red Cross Society, The Principal Recipient supporting the organisation’s activities. The content based on the minimum package guidelines for outreaches included Facts about HIV and AIDS, Prevention With Positives , Sexually Transmitted Infections, Diarrhoea and malaria prevention. Others topics were TB and HIV, Positive living and Referral and linkages.

One of the PLHIV sessions in Khwisero sub county

One of the PLHIV sessions in Khwisero sub county

Other activities planned for were under SDA 2.1 for Prevention of Mother to Child Transmission (PMTCT). Three training outreach events for the women were conducted as planned for reaching 67 pregnant women against planned target of 60. The content disseminated was developed from the PMTCT minimum package for training outreach events and the HCBC training manual. Areas covered included introduction to PMTCT, benefits of family planning, Condom use, Antenatal care and PMTCT as well as importance of HIV testing. Also covered were referrals and linkages.
Under the same SDA, 30 men were also reached through two male involvements in PMTCT training outreach events that were planned for in the month of February 2014. These are separate events conducted with aim of reaching out to the pregnant women’s spouses. The men benefited with information on Facts about HIV and AIDS. Other topics covered were the role of men in Reproductive Health, Sexually Transmited Infections in relation to HIV and AIDS. The role of men in Antenatal care as well as family planning are the essential topics that could not go uncovered. Participants in these events also benefited on information of proper and effective condom use through full sessions on steps of proper condom use for both the male and female condoms

Through the community Health workers’ tracking of pregnant women, the organisation had a target of 60 referrals for skilled deliveries. CHWs continued with tracking and making referrals for pregnant women for skilled delivery in health facilities. Through this, CHWs managed to track 647 pregnant women and referred 92 of them for skilled deliveries. 195 clients among the 647 were newly enrolled for tracking during this reporting period.
Under SDA 3.1 for Leadership and Governance, the organisation through the M&E team comprising of the WADADIA staffs, and CHEWs, was able to conduct all the 9 monitoring visits in the three districts of program implementation that had been planned for.33 PLHIVs clients and 12 expectant mothers were reached.
3 The Community Health Workers’ monthly progress review meetings were conducted under the same SDA. One meeting was held in each district making it a total of three forums as had been planned
Besides the program planned activities, the organisation conducted 2 ANC/PMTCT sensitization meetings as recommended by the PR- Kenya Red Cross Society for the purposes of increasing effectiveness in ANC/PMTCT coverage by the Community Health Workers. The first group had 44 CHWs as well as the second group. The events were held on 18th and 19th for group 1 and 20th and 21st for group 2 respectively.

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WADADIA CBO ACTIVITY HIGHLIGHTS JAN 2014

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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.

 

 

 

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