Here is the full report on the HIV testing Outreach that I have been doing.. it's a bit long, but it's a good read!!
Report
on a HIV Voluntary Testing and Counselling (VCT) Outreach program in Lindi
Region of Tanzania,
funded by the Tanzanian Development Trust
By James Davies.
VSO Volunteer. Laboratory
Scientist, St Walburg’s Hospital, Nyangao, Lindi Rural Region, Tanzania.
Background to HIV and AIDS Prevalence in Tanzania.
The problems associated with HIV infection and AIDS
in Tanzania
are well known and documented. Recent
figures from the 2011-12 Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS)1
show the average HIV prevalence rate in Mainland Tanzania (excluding Zanzibar
where the prevalence rate is low 1.2%) to be 5.3% in men and women aged
15-49. This represents a decrease from
5.8% in 2007-08 and from 7% in 2003-04. (See Figure 1)
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Figure 1. Trends in HIV Prevalence in Mainland Tanzania. Source:
2011-12 Tanzania
HIV/AIDS and Malaria Indicator Survey (THMIS)1
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There are however variations between sexes, with
women having higher prevalence rates than men (6.3% vs. 3.9%) and Tanzanians
living in urban areas are more likely to be HIV positive than those living in
rural areas (7.2% vs. 4.3%). There are large
variations in prevalence rates depending on geographic location ranging from
less than 1% in Pemba to a high of 14.8% in
Njombe region. In general the south
westerly regions of Tanzania
tend to have the higher infection rates (See figure 2)
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Figure 2. HIV Prevalence by region. Source:
2011-12 Tanzania
HIV/AIDS and Malaria Indicator Survey (THMIS)1
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There are many efforts being made to reduce the HIV
prevalence rate through education and through offering free counselling and
testing for HIV at healthcare providing institutes (Provider Initiated Testing
and Counselling - PITC) or at voluntary “drop in” centres (Voluntary Testing
and Counselling - VCT). The success of
these initiatives is shown by the increase in the number of women and men who
have ever been tested for HIV and received their results. In 2011-12, 62% of women and 47% of men said
they had been tested and received their results compared with just 37% of women
and 27% of men in 2007-08. (See figure 3)
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Figure 3. Percentage of women and men who have ever
been tested for HIV and received their results.
Source: 2011-12 Tanzania HIV/AIDS and Malaria
Indicator Survey (THMIS)1
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Whilst improvements have been made to the number of
people tested, there is still a large percentage of Tanzanians who have not
been tested. Also it is important that
people are tested repeatedly, as a
negative result from a single HIV test does not guarantee the client is free of
the virus (due to the sensitivity of the test method) thus clients must repeat
testing after 3 months.
Background to Lindi Region and St Walburg’s Hospital
Lindi region is one of Tanzania’s
26 administrative regions and is located in the South East of Tanzania
bordering the Indian Ocean. It has an area of approx. 67000 km2
and one quarter of this in the northwest is part of the Selous Game reserve2
(See Figure 2)
It is one of the poorest regions in Tanzania, with
almost 60% of the population falling into the lowest two wealth quintile
brackets3. The majority of the population of almost 800,000 live in
rural areas and survive by subsistence farming. The main cash crop in the
region is Cashew nut, which are mainly exported to India.
The latest THMIS report shows the HIV prevalence in
Lindi region to be lower than the national average, at 2.9%1. This may be due to the mainly rural
population, in whom HIV prevalence rates are lower, and due to the work of the Ministry
of Health and Social Welfare (MoHSW) and NGOs in the region to increase
awareness of HIV/AIDS.
The Lindi region is subdivided into 6 districts
(see Figure 4), the Lindi Rural district covers an area of over 7500 km2
and includes the village of Nyangao where the District hospital of St Walburg’s
is situated. The district has a
population of over 200 000 and most of these people live in small villages or
townships4.
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Figure 4. Map of Lindi Districts. Source: Lindi.go.tz 2.
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The ability of village residents to access
healthcare facilities is very limited, since there is only one tarmac road in
the region (From Lindi town to Masasi town in the west) most villages are
accessed by sand/dirt tracks which can be impassable in the rainy season. Thus attending a hospital or dispensary that
offers VCT will involve a walk of many kilometres.
St Walburg’s hospital is the only hospital in the district,
and has an active Care and Treatment Centre (CTC), where patients can come for
VCT, and to receive treatment for diseases such as HIV and TB. The Hospital has for a number of years
received funding from various donors in order to provide an outreach program to
visit villages in the region and provide free testing and counselling for
HIV. These programs have been very
successful in reaching many hundreds of villagers who may not otherwise have
been tested for HIV.
In 2013 however, no funding was available from
usual sources, and so VSO volunteer James Davies applied to the TDT for a grant
to continue the VCT Outreach Program.
2013 VCT Outreach Project
Implementation
In order to continue the work of the VCT outreach
program, the TDT was approached in April 2013 for a grant of TSH 1,250,000 (approx.
£500 GBP) and the grant was approved.
The grant proposal was to visit 6 or 7 villages, with the money used to pay
for the cost of hiring the Hospital vehicle and driver, re-imbursement for the
staff who would give up their weekend days to perform the HIV testing and Counselling
and for some of the associated consumable items. Also there were small monetary payments to
people in the villages that will help to organise visits. The HIV tests themselves are free as they are
supplied by the Government. (See
Appendix 1)
The project was led by James Davies, VSO volunteer,
together with Salvina Mpunga, Site Manager for VCT at Nyangao Hospital
who has organised previous Outreach programs.
Letters were sent to village leaders about a week
in advance to prepare them for our arrival and to ask them to organise a suitable
building to accommodate our visit, along with 2 village helpers, an announcer
and a drum. The visits were arranged for
either a Saturday or Sunday so that the Hospital staff that performed the
testing and counselling would be available and not at work. Two staff from the laboratory and two from
the CTC came to each village visit.
The village visits usually followed a similar
format. We travelled to the village
using the hospital 4x4 vehicle and upon our arrival we were greeted by the
village leader or secretary, and shown to the building that was to be our
clinic for the day. The arranged helpers
and the announcer and drum would ensure that all the villagers knew of our
presence and encourage people to come for testing.
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The Hospital 4x4
vehicle – Essential to access the remote villages
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The building used
for our clinic in Ndawa
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The building used
for our clinic in Mahiwa
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The building used
for our clinic in Mtama A
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When clients came for testing, they were tested
using a simple rapid HIV test. These
tests use a small amount of blood obtained from a finger-prick sample, and
results are ready within about 5 minutes. The test is reliable and easy to
perform making it ideal for such settings where full laboratory facilities are
not available.
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VSO Volunteer James Davies and a member of Laboratory
staff ready to receive clients for testing
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Laboratory staff
taking a Finger-Prick sample of blood
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HIV Rapid test
strip. Blood is applied to the bottom of
the test strip with a drop of buffer liquid.
The blood migrates up the test strip and develops indicator lines. One line in the “control” region indicates a
negative test; An additional line in the “patient” region indicates a positive
test
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Laboratory staff
taking a Finger-Prick sample of blood
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Once the results of the test were ready, the client
was given the results during a confidential counselling session performed by a
trained HIV counsellor from the Hospital’s CTC.
During the counselling session the client was given advice on how to
reduce the risk of HIV transmission and when to come back for another test and
given the opportunity to ask questions
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Two sisters being
counselled by a trained counsellor. (Although usually counselling is on a
one-to-one basis).
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Outcome of the VCT Outreach Project
The TDT grant enabled visits to 8 villages in the
Lindi Rural district over a period of 8 weeks.
This was more than the predicted 7 villages due to budget under spend on
some of the visits. The distance from
the hospital to the village (round trip) ranged from 10km to 64km (See Table
1).
The turnout for each village visit was good and in
total 724 people were tested for HIV.
There was a roughly even distribution of sex; 389 (53.7%) were male and
335 (46.3%) were female (See Table 2) Stratification
by age (age ranges are those used by the MoHSW) also showed a roughly even distribution
between ages (See Table 3).
Of the 724 people tested two new cases (0.3%) of
HIV infection were detected -one male (41 years) and one female (28 years).
Impact and Discussion
The two HIV positive cases identified have been
referred to the Hospital CTC clinic to start treatment on anti-retroviral
drugs. The treatment is provided free
through the MoHSW, and if compliance with treatment is good then these clients
can expect a prolonged and higher quality of life than if they were left
untreated.
The HIV positive rate of 0.3% may suggest that the prevalence
of HIV is low, however it must be remembered that this project was not
measuring overall prevalence rate since people who already know their positive
HIV status will not come for repeat testing.
Furthermore, there is still stigma attached to HIV infection so people
who think they may be HIV positive may not want to know their status.
Besides the two new infections detected, this
project had a number of less tangible but still important impacts. It has increased awareness about HIV
infection in the 724 people who were tested and counselled. The counselling sessions provide valuable
information about HIV infection and ways to reduce the risk of transmission of
HIV. This education is especially
important in the younger generation who are more sexually active, and thus at
higher risk of transmission of HIV. The
THMIS study revealed that 60% of young women and 53% of young men less than 24 years old in the Lindi region do not have a "comprehensive knowledge" about HIV/AIDS5. This Outreach program provided counselling and information for 296 people below 24 years of age.
The project has also helped increase the profile of
the Hospital amongst the residents of these villages. Many healthcare facilities in Tanzania are
understaffed and underfunded and the quality of care provided can be poor. Local people can be afraid of visiting
healthcare facilities if they are not confident about the quality of care and
so will often visit traditional healers or present at Hospital in an advance
stage of disease when it can be too late to provide treatment. St Walburg’s hospital is recognised as being
one of the best in the Lindi and Mtwara regions, and it is important that
people are aware of and have trust in the services offered by local healthcare
facilities as this means they are more likely to seek professional medical help
when they need it.
Although this Outreach program was modest in size,
it was successful and the hospital hopes to continue this year’s Outreach
program when more funds become available in order to reach villages that are
even further from the hospital and thus have less access to VCT and other
healthcare facilities.
Feedback from Hospital
Staff
The following quotations are feedback from staff at
St Walburg’s hospital regarding the TDT funded Outreach program:
From Salvina Mpunga, Site manager, VCT Nyangao:
“Ungozi
wa Hospitali ya nyangao wanatoa shukrani kwa msaada wa fedha ambao wamepata
kutoka kwa TDT ambazo zimetumika kwa shughuli za outreach kwa vijiji ambavyo
vimeizunguka hospitali yetu.
Nitumaini
letu kwamba bado mtaendelea kutufadhili ili tuweze kupunguza kasi ya kuenea kwa
maambukizi ya VVU.
Pia
tunamshukuru ndugu jemsi ambae amefanya kazi kubwa ya kuomba fedha kwenu
Asante”
“The
hospital leaders of Nyangao
Hospital give thanks for
the financial assistance that was received from TDT which has been used for
outreach activities in villages around our hospital. Our hope is that you will still continue for
funding to reduce the spread of HIV infection.
We also thank James who did a lot of work in asking for the money from
you.
Thankyou.
(Translation by James Davies)
From Monica Chalawe, Head of Laboratory, St Walburg’s hospital:
“I have to thank the donors who donated some funds to
enable us to conduct Outreach. It has
helped in different ways, for instance to give education to the people to live
safely from getting HIV and for those affected to show the way of getting ARV
<Anti retroviral drugs> by referring to CTC centres.
Also the outreach exercise helped to build a good relationship with the
surrounding villagers. Thank you a lot to
TDT donors.
From Innocent Chingwile, Laboratory Scientist, St
Walburg’s Hospital:
“Nyangao laboratory is very grateful for you volunteer
services especially financial support.
We have visited many villages providing counselling services and testing
so now many villagers have got knowledge on how HIV is transmitted, best ways
of living with HIV and how to prevent themselves from acquiring. Not only that but also now villagers are more
eager to know their HIV status than before.
More Outreach are needed to cover other remaining villages so that
everyone can be aware of HIV, also to have actual data pertaining to prevalence
of HIV in our community. We together
appreciate your contribution to promote the health of our people”.
References
1. 2011-12 Tanzania HIV/AIDS and
Malaria Indicator Survey (THMIS)- HIV prevalence by region factsheet. Tanzania Commission for AIDS (TACAIDS). March 2013.
- 2011-12 Tanzania HIV/AIDS and
Malaria Indicator Survey (THMIS)-final report. Tanzania
Commission for AIDS (TACAIDS).March 2013.
pp 19-20.
- Tanzania Population and
Housing Census 2002. Available from
http://www.nbs.go.tz/tnada/index.php/catalog/7
- 2011-12 Tanzania HIV/AIDS and
Malaria Indicator Survey (THMIS)-final report. Tanzania
Commission for AIDS (TACAIDS). March 2013. Page 95.
