Tanzania Success Stories: Community Linkages Demonstration Project, Muheza District
Empowering community systems to track lost to follow up
Everything Amina* went through after she stopped using ARVs has remained history as now she has a new and promising life. Although stopping using ARVs was not her choice as the side effects were unbearable; the consequences of leaving the drug were massive. Her health deteriorated and her CD4 rapidly decreased to below 200.
Amina was later admitted in a hospital; however she refused to take ARVs even when she went home after she was discharged. “The pains were too much; I didn’t want to experience it again,” she said.
Fortunately, Upendo Group (a people living with HIV, or PLHIV, group) visited her and talked to her about her health and on the importance of using ARVs. Although it took a while for her to accept to use ARVs, she finally accepted after the group members shared their testimonies of their journeys to their health improvement since they started using ARVs. Their experience made her realize that almost every person went through the similar troubles when they started using ARVs.
The group members also told her more about their group and asked her to join them so she can learn more about ARV adherence and other things they do in a group. Amina is now an active member of Upendo group and among other things; she and her colleagues sensitize other community members on the importance of HIV service uptake.
Community Health System Strengthening Improving the coverage of lost to follow-up (LTFU) for PLHIV was among the objectives of a community linkage demonstration project implemented in Muheza district in Tanga region by the USAID ASSIST Project in collaboration with the Ministry of Health and Social Welfare. The project was implemented in the five villages within two wards by engaging community systems with emphasis on retention of pre-ART and ART clients in care.
USAID ASSIST applied a Community Health System Strengthening (CHSS) Model whereby, the quality improvement intervention is managed by representative from each community group, representatives from the health facilities, and delegates from the local government. They all come together to serve as a collective Community Improvement Team for the purpose of identifying local HIV and health gaps to meet local needs and participate in developing and testing strategies to overcome those gaps.
Health care providers in the two wards faced a challenge in tracking HIV clients who were lost to follow up and even the Home based Care (HBC) programme that was put in place to help out did not show much improvement.
“It was difficult for HBC volunteers to track the clients who are lost to follow up because they are few and the villages are big, it was not easy for them to reach everyone.” said Fausta Sule, a Nurse cum Data Clerk at Mkuzi health centre.
Under the demonstration project, all community groups in the five villages were identified and oriented on applying improvement principles to strengthen the community health systems. Coaches at the district and health facilities were also trained to support the community improvement teams.
During their monthly meetings, group members spend at least an hour to discuss and strategize how to overcome HIV and other health gaps in their community. The challenge of lost to follow up is among the agenda they discuss every time they meet.
Strengthened linkage between health facility and community improves HIV testing
In the demonstration project, utilizing this same CHSS model, ASSIST worked to facilitate the health care providers and community systems in Mkuzi and Kilulu wards, in Muheza district to bridge the communication gap between them and work together to improve health outcomes in the community. Specifically, poor uptake of HIV testing among community members was one of the challenges the team wanted to address.
Ideally, the group members advocate for their families to go for HIV testing and encourage the family members who have stopped HIV treatment to go back to it. Their efforts have demonstrated success in improving HIV testing among community members as well as helped to improve communication chain between the health facility and the community through the community groups and the community improvement team.
“The results are impressing and we are thankful because the community groups have been very helpful. We have been trying hard to track lost to follow up with the help of HBC volunteers but the exercise was slow,” added Fausta.
From January 2014 to May 2014, the number of HIV clients who were lost to follow up reduced from 50 to 7. In order to retain HIV clients who returned to care, health care providers linked them with HBC volunteers who helped them to join groups of PLHIV to continue to receive education on ARV adherence.
“Unlike before when we were not invited to attend the community groups’ meetings, now they invite us to their meetings talk about HIV,” said Magdalena Chambo, a nurse in charge at Kilulu dispensary.
“Voluntary testing has also improved,” she added. “Before, people didn’t go for voluntary testing, only pregnant women came. We were testing 10 to 30 people per month. But now, we are testing more than 100 per month, and more are coming from other villages too, as the information is getting passed.”
Amongst the 3572 people who were sensitized by the community groups to take HIV test, 3096 went for testing whereby 1896 tested at Mkuzi health centre. The health facilities, community improvement teams and the local government with support from the district have also succeeded to organize several outreach testing services whereby many people came out to test. Of those who tested, few were diagnosed positive and referred to the health centre for care and treatment services.