THE POSITIVE ACTION FOR GIRLS AND WOMEN FUND (PAGW) UK PROJECT

Submitted by Danjuma on Wed, 09/04/2019 - 23:31

CFID received grant from Gilead Sciences to implement the project in 6 local council areas of Taraba state in 2017

All Project goals were achieved and surpassed as described below:

  1. To enhance the knowledge and understanding of 400 Health Care Workers/Providers on HIV/AIDS + Viral Hepatitis through Health Education on Injection Safety in the Context of Infection Prevention and Control for behaviour change, in all target communities of Taraba state, by October, 2017: This goal was achieved and surpassed.

The project plan was to reach 400 Health workers across 6 local council areas of Taraba state, but by the end of September, we had reached 462 health workers with tailored intervention messages aimed at increasing their knowledge and understanding on HIV/AIDS and viral Hepatitis prevention in the context of Infection Prevention and Control.

  • 72 Health workers were selected and trained as Master Trainers (12 from each target local council area).

The Master Trainers with supervision from CFID and Ministry of Health Taraba state and the Primary Health Care Development Agency, cascaded down the training for additional 65 health workers from each local council area, making a total of 462 health workers trained on the project.

In each local council area target hospital, Standard Operating Procedures were set up on Injection Safety in the Context of Infection Prevention and Control.

Posters and other IEC materials on Hand hygiene and Waste Management were developed and distributed to all hospital facilities. All the posters had Gilead Sciences brand boldly inscribed as the sponsors of the program.

Geographic Location: Ten (10) wards each in Sardauna, Jalingo, Kurmi, Takum, Zing, Ardo Kola and Wukari local council areas in Taraba state.

  1. To reach 23, 000 community members with Disease awareness campaigns on HIV + Viral Hepatitis Prevention & Injection Safety messages for increased knowledge on personal risk perception of HIV/Hepatitis and for behavioural change, through the provision of appropriate tailored made interventions in all target communities by October, 2017.
  • CFID embarked on series of community based awareness campaigns, Focused Group Discussions and Peer sessions immediately after the step down training, from March till October, 2017. Trained Community Health workers, CFID staff were all involved in the community awareness campaigns, together with trained Community leaders and volunteers.
  • In each target ward, 6 community members, including religious, traditional, women and youth leaders were selected and trained alongside the community health workers during the step-down trainings in each ward. In total, 36 community members were trained during the step down trainings with health workers on Injection Safety in the Context of Infection Prevention and Control.

The essence of training the community members with the health workers was to build ownership, contribute to behaviour change on reducing demands for injection from community members, towards ensuring proper hospital waste management, and reduce the incidence of infections from blood borne pathogens among community members and health care workers in each target community.

The trainings generated a lot of interest from the community members, especially from certain sections of the community who are known to demand for injections more than oral medications. An example is thus:

    • Sunkani Community: A Fulani village head from Sunkani, Mal. Abubakar Audu (his consent was obtained for this report) enumerated reasons behind his people demanding for injections over oral medicines, in his words “most oral medicines are fake, we take it often and don’t get better, that is why we prefer to take injection as it treats our diseases faster than the oral medicines”
    • Another community leader, Sale from Mayo-renuwo said “as far as we are concerned, we prefer the injections to oral medicines, because it works better for us, oral medicines are for children”

In responding to their questions and statements, the facilitators said thus: True, injections are potent and seem to work very fast, but they are to be used only in emergency situations where life saving measures are needed. Injections pose serious risk to the health worker, patient and community, more so in most of the community health center’s where there are very poor injection safety practices, the risk is more than the benefits to the patient. They also enumerated the importance of proper waste management and the challenge it poses to host communities around the hospitals.

During the community awareness campaigns, an average total of about 4,211 thousand community members were reached in each target community through community awareness, Focused Group Discussions, making a total of over 24,000 thousand people in all reached with tailored messages to increase awareness on HIV/AIDS and viral Hepatitis in all target communities.

CFID with support from Taraba AIDS Control Agency (TACA) conducted free HIV screening for 15,304 people in all target communities. 266 people tested positive to HIV and were referred for ART in various hospitals across the state.

CFID also conducted Free Hepatitis B and C tests to 21,602 people in all target locations in the state. We received support from the Taraba state government and Primary Health Care Development Agency in supply of the 10,000 and 5,000 test kits respectively.

A total of 2,601 people tested positive to either Hepatitis B and or C. All clients tested positive were referred the Federal Medical Center Jalingo, for follow up assessment and treatment.

The Primary Health Care Development Agency provided Hepatitis B vaccines for their health workers and community members. A total of 5,705 community members were vaccinated against Hepatitis B infection, making it the largest number to be vaccinated in the state and region of Nigeria. All three doses of the vaccine were provided free for the clients.

CFID had to ensure the clients had received all three doses of their vaccine in-line with WHO guidelines which states 0, 1 and 6 months-time frame.  

By WHO standard, HBV vaccines are given within a space of 0, 1 and 6 month’s cycle.

  1. To provide complete dose of Hepatitis B vaccination as a prevention intervention for 300 Health care workers and 100 persons of concern in all 6 target LGAs in Taraba state, by August, 2017
  • CFID screened a total of 462 Health workers from 6 target local councils in the state. 42 tested positive to Hepatitis B, 12 to Hepatitis C, while the remaining tested negative to both Hepatitis B and C. 5 tested positive to both Hepatitis B & C, as co-infection.

350 Health workers received free Hepatitis B vaccines in all target locations in the state. The vaccine schedules were as follows:

0 Month-March, 1 Month-April and 6 Months-October, 2017, all in line with WHO standard of HBV Vaccine.

  1. Were there any unexpected challenges that impacted the ability to implement the grant project?  If yes, how did you overcome those challenges?

There were few challenges we encountered that could have impacted our ability to implement the grant project:

  • Timing and schedule of HBV Vaccines to Health workers: It is historically stated that most clients given 1st and 2nd doses of HBV vaccines hardly returned for the third dose, majority are lost to follow up.

To mitigate this challenge CFID worked with the Taraba State Primary Health Care Development Agency to ensure that Health workers vaccinated for the 1st and 2nd doses were kept on track to return for their last dose of vaccine received in the last week of October, 2017. All health workers were reminded through mobile SMS and letters from the Agency, asking them to return and complete their vaccines shot.

  • Provision of Community Health HBsAg and Anti HCV tests: CFID was able to leverage HIV and Hepatitis B and C rapid test kits from the AIDS Agency, Ministry of Health Taraba state and Primary Health Care Agency for the HBV vaccines.
  • To ensure that our intervention produced sustainable social and behavioure change, we had to make it evidence-based. Evidence-based programming underlines the importance of collecting baseline and follow-up data to design and evaluate program activities aimed at populations or specific subgroups. This activity was fully funded by CFID Taraba.

    To this end CFID designed and rigorously conducted a KAP and baseline survey which produced data that was informative, insightful and broadly useful in planning our activities for HIV/AIDS and Viral Hepatitis control in Taraba state.

    The Baseline and KAP surveys were conducted at beginning of the project in January, 2017 and an evaluation conducted in October, 2017. Data analysis and reporting was concluded by 20th, November, 2017.

    Sample Population: Health workers, community members (men and women), adolescent boys and girls.

    Sample Size: Health workers (109), community members (180), adolescent boys and girls (96).

    Geographic Location: Ten (10) wards each in Sardauna, Jalingo, Kurmi, Takum, Zing, Ardo Kola and Wukari local council areas in Taraba state.

    The KAP indicated the following results and findings among health workers and community members in all 6 target local councils of the state.

    Key research questions were:

        1. Comprehensive Knowledge of Health workers on HIV/AIDS, mode of transmission and prevention strategies.
      1. Comprehensive knowledge of Health workers on viral hepatitis, modes of transmission and prevention strategies.
        1. Comprehensive knowledge of community members on viral hepatitis and modes of transmission, prevention strategies.
      2. Comprehensive knowledge of community members on HIV/AIDS, modes of transmission and prevention strategies.
  • 3. Knowledge and attitudes of community members on Injection safety and burden of injection in the health system.

     

    KAP Result indicated the following beneficial impact in the lives of the beneficiaries:

    Comprehensive Knowledge of Health workers on HIV/AIDS, mode of transmission and prevention strategies:

    The indicators are reported as Before project and After intervention to show outcome and impact on beneficiaries.

     

    All respondents indicated AFTER, attributed their responses to the outcome of the Project Intervention.

    BEFORE:

    57% of Health workers interviewed reported basic knowledge of HIV/AIDS

    AFTER:

              76% of Health workers interviewed reported improved basic knowledge of HIV/AIDS

    BEFORE:

    58% of health workers reported having some exposure to HIV positive blood samples, and only 5% had access to Post Exposure Prophylaxis (PEP).

    AFTER:

               60% of health workers reported having some exposure to HIV positive blood samples, and 25% had access to PEP intervention: - an increase of 20% showing increased knowledge and reduction in risk of transmission of HIV through needle stick and other hospital based exposures.

     

    BEFORE:

    35% health workers reported having unprotected sexual intercourse with a casual partner 3 months prior to survey.

    AFTER:

               25% health workers reported having unprotected sexual intercourse with a casual partner 3 months after trainings and knowing their HIV status: - a drop in 10% of high risk behaviours attributed to learnings from the project, among beneficiaries is good to contribute towards reducing the incidence and eventually prevalence of HIV/AIDS in Taraba and Nigeria as a whole.

     

    BEFORE:

    65% health workers reported low knowledge on comprehensive HIV prevention strategies.

    AFTER:

               78% health workers reported increased knowledge on comprehensive HIV prevention strategies attributed to the project intervention.

     

    BEFORE:

    63% of health workers reported using condoms correctly and consistently during sexual intercourse with a casual partner 3 months prior to survey.

    AFTER:

             64% health workers reported using condoms correctly and consistently during sexual intercourse with a casual partner 3 months after intervention. This would contribute to reducing the incidence of HIV in the state over time, if sustained.

     

    BEFORE:

    45% health workers reported not knowing their HIV status, due to fear of stigma.

    AFTER:

               71% health workers reported conducting HIV tests to know their status. Early detection and treatment for HIV positive clients promotes healthy living.

     

    BEFORE:

    56% of health workers reported not having Personal Protecting Equipment (PPE) such as Laboratory coats.

    AFTER:

               72% health workers reported procuring Personal Protecting Equipment with their personal resources, after training, while awaiting supply from government

     

    Comprehensive knowledge of Health workers on viral hepatitis, modes of transmission and prevention strategies.

    BEFORE:

    66% health workers reported very low knowledge on viral hepatitis, especially Hepatitis B and C disease conditions, modes of transmission, prevention and treatment.

    AFTER:

                79% health workers reported increased knowledge on viral hepatitis A, B, C, D and E: their modes of transmission, prevention, treatment and care.

     

    BEFORE:

    34% health workers unaware of the current best practices and WHO protocol on HCV and HBV treatment and management.

    AFTER:

               88% health workers aware of the current best practices and WHO protocol on HCV and HBV treatment and management.

     

    BEFORE:

    44% health workers have been previously tested for Hepatitis B or C and know their status.

    AFTER:

               60% health workers have been tested after the intervention and know their HBsAg and Anti-HCV status. Identifying people living with hepatitis early into their conditions gives hope of accessing quality treatment to reduce disease progression in HBV cases and cure for HCV clients. While people tested negative received life-long protection through HBV vaccination.

     

    BEFORE:

    12% health workers previously tested negative for HBsAg had received complete dose of HBV vaccine.

    AFTER:

                100% health workers tested during and after intervention received complete 3 dose of HBV vaccine in line with WHO protocols. A great impact in the lives of the beneficiaries.

     

    BEFORE:

    65% health workers tested HBsAg negative have received incomplete HBV vaccination.

    AFTER:

               100% health workers tested HBsAg negative received complete dose of HBV vaccine.

     

    BEFORE:

    55% of health workers tested positive to HBV or HCV receiving some herbal treatment outside hospital setting.

    AFTER:

               10% health workers tested positive to HbsAg and Anti-HCV received unorthodox treatment outside the hospital setting. A decline in the number receiving treatment from outside the hospital setting, means an increase in people receiving quality life-saving treatment in recognized hospital settings.

     

    BEFORE:

    55% health workers reported injections to be more effective to oral medications.

    AFTER:

               25% health workers reported injections to be more effective to oral medications. A decline in the number of health workers reported to use injections, thereby reducing the burdens of injections, which was one of the key goals of the project, and ultimately reducing the risks of transmission of blood borne pathogens among health workers and community members.

     

    BEFORE:

               56% health workers not sure of their HBV or HCV status, due to fear of stigma and      discrimination.

    AFTER:

               100% health workers trained conducted HBsAg and Anti-HCV tests and know their status. Knowing one’s status emboldens people to make health life choices.

     

     

    BEFORE:

    45% health workers reported to have recapped needles, 38% do not segregate waste, 17% have reused hand gloves during any medical procedures.

    AFTER:

               20% health workers reported to have recapped needles, 65% segregated waste at point of collection, 15% had reused hand gloves during medical procedures.  A great achievement for the project. As the risks of infection through needle stick injuries is reduced and hospital waste management contributes to infection prevention and control in health settings and host communities.

    BEFORE:

    59% health facilities do not have SOPs on blood collection, waste management and waste disposal pasted on strategic locations in their facilities.

    AFTER:

               100% target health facilities had SOPs on blood collection, waste management and waste disposal pasted on strategic locations in the facilities. Thus contributing to strong health systems at the Primary Health Care levels in all target local councils.

    BEFORE:

    1% health facilities had an Incinerator, 76% employed “Dig and Bury method of waste disposal, and 23% had neither Dig and Bury nor incinerators for disposal of all hospital wastes.

    AFTER:

              11% target health facilities had an Incinerator, 89% had “Dig and Bury” waste management system for disposal of all hospital wastes. An improvement in hospital waste management improves infection prevention and control in health settings and community, which was one of the goals of the project.

    Comprehensive knowledge of community members on viral hepatitis and modes of transmission, prevention strategies.

    BEFORE:

    87% of community members (men and women aged 18years to 45years) reported low knowledge on viral hepatitis B and or C disease conditions, modes of transmission, prevention and treatment.

    AFTER:

              50% of community members (men and women aged 18years to 45years) reported low knowledge on viral hepatitis B and or C disease conditions, modes of transmission, prevention and treatment. An increased level of awareness on viral hepatitis was a major goal of the project. More people knowing about viral hepatitis improves health seeking behaviours, reduction in high risk behaviours and prevention and treatment outcomes, thus contributing to the Global Elimination Goal of viral hepatitis.

     

    BEFORE:

    34% of community members (men and women aged 18years to 45years) in rural communities and 66% in urban areas reported having been previously tested for Hepatitis B or C and know their status.

    AFTER:

               56% of community members (men and women aged 18years to 45years) in rural communities and 82% in urban areas reported having been previously tested for Hepatitis B and or C and know their status. Low access to hepatitis testing and diagnostics was identified as major gap which the project addressed. More people knowing their hepatitis status contributes in reducing risks of developing liver complications as people seek for treatment and or prevention through HBV vaccination.

    BEFORE:

    12% of those previously tested negative for HBsAg have received complete dose of HBV vaccine.

    BEFORE:

    56% community members have never been tested for Hepatitis B or C before, therefore do not know their status.

    AFTER: 85% community members that were screened received complete dose of HBV vaccine. An increased number of high risk people protected against infection with Hepatitis B and ultimately Hepatitis D.

     

    BEFORE:

    48% community members tested positive to either Hepatitis B or C and receiving some forms of medication outside the hospital setting.

    AFTER:

               100% community members screened under the project were referred and commenced receiving treatment and management in designated hospitals in the state. This improves health outcomes and living.

     

    BEFORE:

    35% community members reported asking for injections rather than oral treatment during visit at the hospital or health centre.

    AFTER:

                18% community members reported preference for injections over oral treatment after intervention. Thus reducing the burden of injections and further reduction of hospital waste and risk of needle stick injuries among health workers and patients.

     

    BEFORE:

    23% community members, male (40%) and female (15%) reported having unprotected sexual intercourse with a casual partner 3 months prior to survey. 38% declined making any response.

    AFTER:

               15% community members, male 65% and female 35% reported having unprotected sexual intercourse with a casual partner 3 months within the life cycle of project. With increased awareness on HIV/AIDS and Viral hepatitis prevention strategies, more people reduce high risk behaviours that increases their risks of acquiring and transmitting infections.

    BEFORE:

    45% community members reported to have seen used needles or other contaminated hospital tools thrown outside the health centres, wall or fence.

    AFTER:

               20% community members reported to have picked up used needles or other contaminated hospital tools outside health facility after interventions.

    Comprehensive knowledge of community members on HIV/AIDS, modes of transmission and prevention strategies.

    BEFORE:

    45% of community members (men and women aged 18years to 45years) reported high knowledge and understanding on HIV/AIDS, modes of transmission, prevention and treatment.

    AFTER:

               55% community members reported comprehensive knowledge on HIV/AIDS, modes of transmission, prevention and treatment.

     

    BEFORE:

    34% of community members (men and women aged 18years to 45years) reported having been previously tested for HIV and know their status.

    AFTER:

               60% community members reported to have been tested and know their HIV status during intervention. More people knew their HIV status, thus identifying people in need of treatment and helping others adopt safer sex practices and reduction in high risk practices.

    BEFORE:

    39% community members (men and women aged 18years to 45 years) reported engaging in multiple sexual relationship.

    AFTER:

               25% community members reported to be in multiple sexual relationship after intervention. A great reduction in high risky behaviours reduces the chances of acquiring and transmission of STIs, such as HIV and viral hepatitis.

    BEFORE:

    26% benefitting community members (men and women aged 18years to 45years) reported having unprotected sexual intercourse with a casual partner in the last 3 months.

    AFTER:

               20% benefitting community members reported to have engaged in unprotected sexual intercourse with a casual partner within life cycle of intervention.

    Knowledge and attitudes of community members on Injection safety and burden of injection in the health system.

    BEFORE:

    35% community members (men and women aged 18years to 45years) in two target local councils, and 48% in four target local councils reported demanding for injections from health workers rather than oral treatment during visit at the hospital or health centre.

    AFTER:

              30% community members across all target communities had preference of injections over oral medication after intervention.

    BEFORE:

    43% community members reported being exposed to sharps and other contaminated hospital waste outside the hospital or health centres in host communities.

    56% community members in 4 local councils and 44% in 3 other local council areas of intervention expressed preference to injectable and consider it more potent over oral medication.

  • The Grant Implementation Team:

    Dr. Daudu Nyubanga (+234 7087630562)-his consent was obtained to share  his story and phone contact- from the Taraba State Ministry of health had this to say: “even as a Medical Officer of so many years, I never knew this much about viral hepatitis, especially the prevention, and new approaches to the treatment, we have been doing the wrong things all this while, I wish this project will continue to all the 16 local council areas of the state and health workers including Doctors be trained on viral hepatitis. Thank you CFID and Gilead Sciences for the support.”

  • Zakari Chido (+234 7085214075)-his consent was also obtained- He represented the Taraba State Primary Health Care Development Agency, had this to say: “this project is very unique, it has helped our health workers in all the target council areas, with knowledge and understanding about HIV/AIDS, but most especially about viral hepatitis, which is a serious problem in our communities in the state. Many of our people are living in darkness about this diseases, but with this project many lives have been saved, we thank CFID NGO for working with us and providing the services to our health workers in the state, our agency is very happy and will partner with such serious NGOs any time, we also thank Gilead for the support given to the NGO
  • Responses from Community or project beneficiaries:

  •        Chief Nursing Officer General Hospital Gembu, Sardauna LGA (+234 8147997331): before now we were just doing so many wrong things, and did not know we are exposing ourselves to dangers. I have been on this job for over 20 years but have not received this type of training before, that’s why you see I left my office, though a very busy office, to seat and learn. From now going forward we have started implementing your recommendations on hospital waste, we did not know we were putting our neighbouring communities in danger and our staff too due to poor hospital waste system”
  • Mrs Mekan (+234 8065300873)-Senior Nurse, In-chage of GOPD, Gembu said; this project has helped us a lot to know so many things about viral hepatitis which we never knew before now. Thank you to the NGO and your donor.
  • Community leader from Ardo-Kola LGA: “we are Fulanis by culture, and because of our experience we always prefer injections to oral tablets because most of the oral tablets are fake and do not work for us, but with this project now, I will work to encourage our community members to always take oral tablets more than the injections, due to the risks of injection problems”. Before this project we did not know anything about Hepatitis, we use to take it that it is “yellow fever” when the eyes turn yellow, but now we know how dangerous it is, so we would work to prevent it and take our people to hospital whenever they are sick and not any traditional treatment of this disease”. Thank you to you all”
  • CFID TARABA (NGO):

                    The Gilead Sciences grant to our NGO has helped us make the largest impact on affected populations and communities since the inception of the organization. Through this grant we provided services to more than 20,000 people, more than 400 health workers in 6 local council areas of the state. The grant also afforded us opportunity to partner with key state actors in delivering the services providing us opportunities for future partnerships and strengthening linkages with other implementing agencies and institutions in the state.    

    The KAP and Evaluation surveys we conducted has provided us with valuable data that will inform future programing and interventions in the state, across the health systems and community based interventions.

    One of the gaps identified is gap in knowledge and expertise on Viral Hepatitis Prevention, Treatment and Care Protocols in Nigeria, among health care providers. Also of interest to us is the need for Patient Empowerment as a key component of improving health outcomes in the state.