1. Providing Treatment, Restoring Hope FAITH BASED COMMUNITY NETWORKS A STRATEGY TO COMBAT HIV/AIDS PANDEMIC IN TANZANIA

2. Slide 2 BACKGROUND  HIV/AIDS is one of the top ten causes of morbidity and mortality in Tanzania  1 st case in Tanzania reported in 1983  By December 1985, 20 regions of Tanzania mainland had reported AIDS cases  Currently a national problem affecting every corner of the country

3. Slide 3 AFRICA

4. Slide 4 TANZANIA  Estimated total population -39 million  National HIV Prevalence: 6% (5.8% M and 6.2% F) To date, there are 2.2m PLWHA, with estimated # of OVCs: 1.1M (THMIS, MoHSW 2006)  Tanzania’s target is to reach 400,000 patients who are in need of Antiretroviral therapy by 2009.  By end of December 2008, a total of 641,400 patients were enrolled in care & treatment and among them 120,000 were on ARVs

5. Slide 5 AIDS RELIEF AIDSRelief (AR): A PEPFAR funded ART program – Implemented by: IMA World Health (IMA); Catholic Relief Services (CRS); Futures Group International (FGI); University of Maryland School of Medicine, Institute of Human Virology (UMSOM-IHV ) AR is responsible for 4 out of 21 regions in the country – to provide technical assistance and supervise all ART activities.

6. Slide 6 HIV PREVALENCE (% PER REGION) * THMIS II 2007 1 2 3 4 1. MWANZA 2. MARA 3. MANYARA 4.TANGA 5.6 %, Pop.2.8m 7.7 %, Pop. 1.3m 1.2 %, Pop. 1.0m 4.8 %, Pop. 1.6m REGION HIV PREV.

7. Slide 7 ART SERVICES Current model for ART Services in Tanzania Care and Treatment of HIV/AIDS Prevention of Maternal to Child Transmission of HIV TB/HIV Home Based Care (HBC) Voluntary Counseling and Testing (VCT)

8. Slide 8 CHALLENGES FACING ART PROGRAM 1. Inadequate Human resources a crisis - worsened by HIV/AIDS : Overburdened Care and Treatment Clinics’ staff and general inadequate resources make outreach services difficult and limited.

9. Slide 9 CHALLENGES FACING ART PROGRAM 2. Weak or absent linkages between Care and Treatment Clinics and Communities leading to: Lack of adherence support to patients on ARVs Lack of psychosocial support Increased number of patients lost to follow up ( with bad consequences on the ART Program outcomes)

10. Slide 10 CHALLENGES FACING ART PROGRAM 3. Stigma – contributing to poor enrollment 0.and compliance to ART services 4. Poverty- worsened by the chronic nature of the disease 5. Increased number of Orphans

11. Slide 11 CHALLENGES FACING ART PROGRAM…….. How do we handle these challenges ?  The fight against HIV/AIDS can only be sustainable if owned by the people in the communities we serve.  Therefore, Community involvement through FBOs, NGOs / CBOs initiatives is imperative!

12. Slide 12 CHALLENGES FACING ART PROGRAM…….. In considering some of the solutions; AIDS Relief recognized the importance of developing partnerships with existing FBOs in target regions as a key strategy for increasing access to health services and focusing on sustainability. In addressing the problem of inadequate linkages between CTCs and the community, IMA through AIDS Relief came up with a simple, sustainable model, which is easy to implement at very low cost.

13. Slide 13 FBO MODEL GOVERNMENT HEALTH FACILITY COMMUNITY CHURCH

14. Slide 14 KANISA LA MENONNITE SHIRATI MODEL HUB HEALTH FACILITIES CARE &TREATMENT CLINICS SUB- HUBS SUB- HUB V VOLUNTEERS PLWHAs 15 TO 20 PEOPLE PLWHAs GROUPS 15 TO 20 PEOPLE PLWHAs GROUPS 15 TO 20 PEOPLE CHURCH AT COMMUNITY VV PLWHAs 15 TO 20 PEOPLE LOCAL GOVERNMENT NGOs /CBOs

15. Slide 15 T THE FBO COMMUNITY NETWORK Objectives 1. To facilitate easy tracking of patients and reduce loss to follow-up at the treatment centers 2. To create patients treatment clubs for supporting each other to enhance adherence to ART, offer psychosocial support and reduce stigma. 3. To enhance two-way referral systems 4. Community mobilization for service utilization 5. Through organized and coordinated PLWHA groups, to facilitate easy access to other services (IGAs, prevention messages, spiritual support, Psychological support etc)

16. Slide 16 WHY FBOs Have networks that have access to hard to reach populations Have the ability to influence the attitudes and behaviors of their community members by building on relationships of trust and respect Have existing structures that can coordinate a scalable response Are committed to the cause of care and support for those in need from a spiritual perspective

17. Slide 17 WHY FBOs…… Are uniquely positioned to promote HIV/AIDS stigma reduction, follow up patients on treatment and send out prevention messages The FBO structures at the lower levels (e.g. church level) are usually the first and at the frontline to respond to the patient’s need for support in terms of spiritual and material needs These attributes make the partnership with them a valuable asset in the fight against HIV/AIDS

18. Slide 18 SUCCESS/ACCOMPLISHMENTS Number of community groups formed 130: KMT Mara Region – 90 groups ACT Tanga Region - 40 groups A total of 1700 patients have joined the groups. In Shirati, >50% of patients enrolled at Care and Treatment Clinics have joined the groups

19. Slide 19 SUCCESS/ACCOMPLISHMENTS  Reduced lost to follow-up at CTCs. (Out of 176 patients lost to follow -up at Shirati CTC in 2008, 156 patients {89%} were traced back through the program)  Enhanced adherence support among group members – giving wonderful results.  Community groups have created forums for PLWHAs to voice their needs and suggest solutions.

20. Slide 20 SUCCESS/ACCOMPLISHMENTS 4. Community Groups contribute to HIV prevention by; encouraging disclosure Enhancing voluntary testing among community members Providing group therapy with members, sharing their fears and hopes, and encouraging each other “peer support” for each other 5. Stigma reduction As more people check their sero-status and join the Community groups, stigma and discrimination level slowly declines

21. Slide 21 SUCCESS/ACCOMPLISHMENTS 6.Local Governments’ buy in; A sign of sustainability  Using groups for distribution of support e.g food.  Including groups in their annual plans and budgets. 7. Community groups create a sense of responsibility among PLWHAs. They identify the most needy among them to be given priority for the available limited resources. IGA 8. Improved family income; Groups are motivated to start self support activities – IGA

22. Slide 22 SUCCESS/ACCOMPLISHMENTS 9. Health monitoring - share body weight results and encourage each other on good nutrition - remind each other on CD4 check dates/follow-ups visits to clinics 10. FBOs/ CBOs/NGOs are mobilized to network for effective support of PLWHAs, sharing of information, best practices & challenges.

23. Slide 23 THE IMPACT 1. GRACE’S STORY GRACE, a widow, with two children was abandoned by her husbands relatives, who took the very few belongings that she had and chased her away from her family home. Grace was HIV positive and was started on ARVs A SHELTER FOR GRACE AND HER 2 CHIDREN- DONATED BY A GOOD SAMARITAN

24. Slide 24 THE IMPACT This was all what Grace had in her bed-room

25. Slide 25 IMPACT Grace decided to stop her ARVs because she had not enough food and had no strength to work. Jaclyn, Graces’ daughter dropped from school and started working for food to support her mother and her young sister.

26. Slide 26 IMPACT GRACE GOT SHELTER AND FOOD SUPPORT, RESUMED HER ARVs JACLINE WAS RE-ENROLLED IN SCHOOL PROVIDED WITH SCHOOL UNIFORMS AND OTHER NEEDS. Through the FBO Community network program…….

27. Slide 27 THE IMPACT 2. IMMACULATE,S STORY SERIOUSLY SICK WITH OPPORTUNISTIC INFECTIONS (2007). “I was waiting for the day of death” she said.

28. Slide 28 “Thanks to the work of AIDS Relief through the Anglican Church, Tanga” she said “With the support of PLWHA groups, I have overcome my fears and have attained 100% adherence to my ARVs regimen”. IMMACULATE ON ARVs (2008) THE IMPACT

29. Slide 29 The District Commissioner (center) joined the walk. 700 people tested their HIV sero- status THE IMPACT 3. Anti stigma campaign Charity walk organized by Shirati PLWHA support groups- Feb 2009

30. Slide 30 FBO (PLWHA) SUPPORT GROUPS CHALLENGES Maintaining functional and sustainable support groups Food shortage – interfering with adherence Stigma in the community is still an issue that groups have to deal with POVERTY- Lack of substantial capital to start IGAs Documentation - not always adequate and need continuous capacity building

31. Slide 31 RECOMMENDATIONS 1.Enhance collaboration between FBOs and government to integrate FBOs as main partners in ART community work 2.Leverage additional resources (sustainable) for full engagement of FBOs so that ART work in the community is accelerated. 3.Systematically document and disseminate lessons learned & best practices of FBO initiatives 4.Encourage inter-religious, inter-Organizational collaboration and networking

32. Slide 32 PARTNERSHIP IS POWER