Download Group 1.4 Follow-up and retention

Follow up and retention for Treatment
and PMTCT
Members
• Angela Mushavi-Zimbabwe
• Martin Sirengo-Kenya
• Bernard Dornoo-Ghana
• Micheal Eliya-Malawi
• Godfrey Esiru-Uganda
• Vuyelwa Chitimbire-Zim
• Claudia Kazadi-USA
Background
• Retention important especially for life long
ART
• In the past PMTCT programs were not keen on
retention because of single pills-sdNVP
• With emergence of more efficacious regimens
including Option B plus, there is now need for
adherence and retention
Strategies-GOK
1.
2.
3.
4.
Scheduled counselling sessions
Rx supporters
Peer support groups
Community response
 CHWs –Primary health care initially but now role
expanding to take care of HIV aspects
5. mHealth initiatives-Use of cell phones
Strategies-FBOs
1. Implement Govt initiatives on top of own
parallel initiatives
2. Collaborations
 Use govt protocols and training curricula
 Focus on holistic approaches for all the health
needs of clients
 Outreach work
 Mentor patients to boost adherence
Strategies-FBOs
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Decentralized commodity supply
HBC initiatives
Capacity building-MCH counsellors
Infrastructure development
Equipment for MCNH
School programs
Challenges in Govt-FBO partnerships
• Attitudes about mandates of each
• Weak involvement of FBO leadership in planning
for HIV activities
• Parallel programming
• Lack of equity in programming leaving out some
areas e.g. hard to reach places
• Weak logistics management for supplies and
commodities
• Distance to access Health facilities an
impediment to access
Challenges in Govt-FBO partnerships
• Culture and traditional beliefs limiting access
• Stigma and discrimination
• Poverty
Discussion
Strategies that may address retentionComplementary to each other
1. Interventions at health facilities to
– Improve quality of service
– Improve attitudes of health care providers
– Treatment supporters
– Reduce waiting time
– Reinforced counselling for women to understand
why its important to remain in care and adhere to
medication
Strategies that may address retentioncont..
2. Mother baby booklets/cards and other tools for
tracking clients
3. Actual follow up
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Use of mobile phones
Use of peer supporters/
Support groups
4. Community response
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Support groups at community level
CSOs
CHWs
Referral system between Community and facilities
Use of church structures for retention
• Break the religious beliefs that stop people
form going to health facilities of taking
prescribed medications
• Use the church teachings to break
retrogressive traditional beliefs and traditions
Key recommendations for Govts and FBOS
1. Improve quality of service at health facility to
improve client satisfaction-HCWs attitudes, train
HCWs, Infrastructure improvement, fast and timely
services, avail commodities and supplies, integrate
services (One stop shop), POC solutions e.g. CD4,
EID etc
2. Client education and counselling: Reinforced
counselling for women to understand why its
important to remain in care and adhere to
medication including community structure support
and response. Respond and accommodate cultural
beliefs that keep women away from hospitals
Key recommendations for Govts and FBOS
3. Strengthen peer support and defaulter
tracing tools and mechanisms:
 Standard M&E system-Cards/registers, EMR,
mHealth initiatives, Smart cards, appointment
books and other referral and linkages tools.
 Peer support initiatives:- Mentor mothers,
support groups, CHWs etc