Community Engagement to Support the HIV Outbreak Response in Sindh, Pakistan

Summary:

An outbreak of HIV was declared in the north-western district Larkana of Sindh Province in May 2019-the eighth reported outbreak in the country, and the fourth in Larkana. Over 36,643 people have been screened from April to September 2019, out of which 916 (80%) of HIV positive cases have been among children below 15 years of age. The Sindh AIDS Control Programme (SACP) with support from partners has been responding to the outbreak through various interventions, of which Community Engagement (CE) is a strong component. Rapid assessment on CE led by UNICEF and UNAIDS, with SACP; and qualitative assessments during community visits by programme teams, revealed a lack of understanding among the population on HIV transmission and health seeking behavior. The mode of transmission has mostly been through malpractice in injection use and poor infection prevention in health facilities. Informed by the findings of the rapid assessment, the CE plan was developed. Communication material were produced through a consultative process under the leadership of SACP. It was pre-tested in the affected communities and translated into local languages. Social mobilisers use these to educate families/ communities. A local civil society organization has been engaged for CE. Based on the community mapping, various interventions have been conducted, through house to house visits, community dialogues and dissemination of generic mass media messages. Various cadres of communities have been trained on HIV prevention and response using customized training modules. CE has been closely linked to service strengthening and establishing referral mechanisms.

Background/Objectives:

To respond to the outbreak of HIV in Larkana district of Sindh province in Pakistan, an evidence-based community engagement strategy and plan was developed. It aims to increase knowledge among family/caregivers and communities about HIV prevention and treatment, and to promote positive behaviours related to HIV and referral; as well as to reduce stigma and discrimination. It also aims to build the capacity of frontline workers and service providers in interpersonal communication (IPC). Ultimately, the aim is to contribute to reduce HIV incidence in the district and to encourage families to seek comprehensive treatment and care including ARV adherence.

Description of Intervention and/or Methods/Design:

Rapid assessment and qualitative findings from field missions and consultations with communities informed the C plan and approaches. Communication approaches and material were designed by UNICEF according to the community needs, following a consultative process with relevant partners led by SACP. It was pre-tested, finalized and translated into local languages and is being used by social mobilisers to educate families/care givers. Community mapping done with community participation, was used as the basis for targeted approach to reach households with interventions. Community empowerment was ensured through various capacity building training to enable them to demand for services. Community cadres including lady health workers, social mobilisers, religious leaders were trained using customized training modules developed by UNICEF/SACP. Media training were conducted in Karachi and Larkana. Multiple communication channels including IPC and targeted mass media were used for maximum impact. CE task force has been established under SACP for coordination purpose.

Results/Lessons Learned:

Evidence based community engagement plan and a long- term C4D strategy has been developed to guide the communication approaches. Integrated communication and training material were produced. Community mapping was completed in 435 villages and 75 mohallas (neighbourhoods); 150 religious leaders, 113 teachers, 153 community leaders and 157 women leaders were trained. About 187 mother support groups and 237 father support groups have been created to support CE activities. Social mobilisers identified 206 mothers, 237 fathers and 545 siblings of positive children, who had not been screened for HIV; and referred them for testing. Having a good partnership and coordinated approach to communication is effective in reducing duplication and for joint ownership of stakeholders. Evidenced based information was critical in designing appropriate CE interventions to respond to community needs. Community mapping helped to have focused/ targeted approach to reach affected populations. HIV is multisectoral and needs integrated communication approach.

Discussion/Implications for the Field:

Community engagement is a key component of HIV prevention, response and promotion of positive behaviours. Even though HIV has not been a priority in the country, the recent outbreak in Larkana has pushed for a long-term HIV response strategy. Lessons learnt from the CE interventions will contribute to development of culturally relevant and practical interventions to address various needs of communities/care-givers. The CE and training material available can be easily adapted and used for other provinces of the country. The nexus between emergency and development programme needs to be strengthened-building onto the gains of the outbreak response.

Abstract submitted by: 

Deepa Risal Pokharel

Ayesha  Durani

Ayaz Hussain

Muhammad Faisal  Khalil

Saqib Ali Shaikh