Linkages, Referrals and Integration

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Linkages, Referrals and Integration

• Integration of CT in Public Sector in Mozambique

International HIV Counseling and Testing
Workshop January 21-24, 2008 Lusaka, Zambia
Fungai Chinhacata - Mozambique
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Presentation Overview

• Epidemiology of Mozambique
• Current CT services
• CT in Health Approach ATS
• Referrals
• Lessons learned
• Challenges

3
HIV Prevalence Trends

• ANC Surveillance 2007 - 16 HIV National
  Prevalence
  
• About 1.500 million PLWHA, and 500 new infections
  per day (2002 data)

2007 ANC Surveillance, MOH Mozambique 2007
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Annual Achievements Number of Persons Receiving
CT Services
MOH National CT Program Data PEPFAR Annual
Report 07, Mozambique
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Mozambique CT Services (1)

• Services began in Mozambique at 4 sites in 2000
• According to Ministry of Health (MOH) data,
  401.303 clients attended CT services at 359 CT
  sites in 2006
  
• Mozambique is currently providing CT services
  through three strategies
  
• Provider-Initiated CT (PICT) in clinical
  settings
  
• Community-based CT (CCT) and
• CT in Health.

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Mozambique CT Services (2)

• Provider-Initiated CT (PICT)
• TB clinics, ANC, maternities, in-patients
  services, pediatric settings etc.
  
• CT in Community settings (initiated in 2006)
• Non traditional settings, e.g. mosques, churches,
  schools
  
• Satellite
• Campaigns (corridors, borders etc.)
• Home based CT
• Client-Initiated CT (CICT)
• Facility-based CT in Health

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What is CT in Health?

• Introduced in 2006 to include health promotion
  and prevention activities aimed at increasing the
  number of people who access health services.
  
• Continuation and expansion of HIV CT
• Systematic Tuberculosis and Sexually Transmitted
  Infections screening and referral as needed
  
• Introduction of hypertension screening and
  referrals
  
• Counseling on malaria prevention at facility
  level referrals at community level
  
• Orientation on Sexual Reproductive Health in
  particular diagnosis of early pregnancy and
  promotion of institutional delivery
  
• Environmental health education, case finding for
  diarrheal and skin diseases and referrals from
  the community level

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CT in Health Pilot

• Production of National Guidelines for CTH
• Manual for Counselors
• Pilot experience 2 Urban sites and 1 Peri-urban
  site
  
• From March to May 07 of the 5742 patients
  that visited the 3 sites
  
• 100 tested and received results
• 42,3 (2433) accepted to be seen within the CTH
  approach
  

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TB symptoms
10
Type of Counseling
N 2433 patients
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HIV Negative PatientsReferred to Other Services
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Linkages and Referrals

• Participation of health providers, managers and
  partners in CTH training with non-medical
  counselors
  
• Referral flow built in close collaboration with
  counselors and managers
  
• Better relationship among teams (CTH, TB, Lab,
  etc.)
  
• Integrated supervision partners, MOH,
  Provincial and District level involvement
  

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Linkages and Referrals

• Strenghtening of the referral system
• HIV(-)
• Referred to TB clinics, Medical Consultation -
  STI, Hypertension etc.
  
• Patients that came to access blood pressure
  measurement, were offered HIV test
  
• HIV ()
• Referred to Care and Treatment services
• Screened for TB and referred to TB Clinics where
  needed

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Lessons learned

• Advocacy at all levels about CT as both
  prevention intervention and entry to care and
  treatment
  
• Involvement of health managers from Provinces and
  Districts in the organization of referrals
  
• Mobilization of groups resulting in increased
  number of people tested for HIV
  
• Opportunity for integration of Prevention with
  Positives
  
• Successfull involvement and referrals to support
  groups
  
• Special services to young people
• Availability of clinical services on site
  contributing to increased CT service up-take

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CHALLENGES (1)

• Human Resources shortage
• Tracking of patients referred to clinical
  services
  
• Monitoring outcome of referral - ensure uptake of
  care and treatment
  
• Ensure training at all levels to increase
  effective referrals
  
• Quality control - ensure continuing counselor
  supervision for both counseling, and testing

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CHALLENGES (2)

• Mobilization for early diagnosis of HIV, TB, STI
  and other diseases
  
• CT services targeted to vulnerable populations
• Need for complementary activities to address and
  prevent gender based violence (anedoctal evidence
  of GBV related to HIV testing and disclosure)