(MARPS) in Zanzibar - Columbia University Medical Center

Developing a system for collecting strategic
information on Most at Risk Populations (MARPS)
in Zanzibar
Co Authors: Nuwagaba-Biribonwoha H, ICAPTZ/CU, Haruni, M, ICAPTZ/CU
Chen S, Gongo R., CDC Tanzania , Juma M.S , Shaka S.,ZAYEDESA Saito S.,
Strachan M, ICAPTZ/CU Mbatia R.J ICAPTZ/CU, Cunningham A.ICAPTZ/CU
Frida Radegunda Godfrey
2009 HIV/AIDS Implementersʼ Meeting
13 th June 2009

• Background
• Approach
Presentation Outline
• Program Activities
• M&E Tools
• Challenges
• Conclusion & Way foward

• Zanzibar
has a population of 1.1m
Background
• HIV prevalence rates in Zanzibar among the general population is

Background Cont’d
• In 2008 ICAP TZ/ Columbia University won a new project- United
for Risk Reduction and AIDS Prevention (URRAP) focuses on
addressing HIV prevention, care and treatment among most at risk
persons in Zanzibar
• URRAP main activities:
- Outreach to drug users and other MARPs to support HIV testing
- Support for risk reduction strategies
-Referral to HIV care providers for HIV infected drug users/ MARPs.
- Sensitization of care providers to the specific of HIV infected drug
users
- Reduce stigma and discrimination that impede utilization of services
by drug users
- Development of M&E indicators, tools and database

Approach
• Implementing the program in collaboration with the
Government of Zanzibar ( MOH)
– Zanzibar AIDS Control Program
– Department of Substance Abuse Prevention
• NGOs are primary implementers for the outreach
services
– ZAYEDESA, ZAIADA, Zanzibar Youth Forum
• Peer Educators for effective outreach with drug users/
MARPS
• Former drug users/those in recovery serve as peer
educators
• Linking target population to HIV services & drop-in
centres

Areas of Operation for NGO
Peer Educators
PEMBA ISLAND

Results - M&E Tools for reporting
• Form A, for reporting one–on–one interactions between outreach
workers and IDUs/ MARPs – behaviour change strategies
• Form B, reporting services provided in groups for drug users and
general community eg. community meetings and drama/ cinema
shows
• 2-way referral form:
- Referral form, used to refer a client to HIV service
- Feedback form, give feedback to NGOs
• Monthly Summary Form (MSF) for aggregate reporting
• Electronic web-based reporting system -It is a computerized system,
Access to NGOs to enter the collected data electronically, the
NGOs and other MARP stakeholders can access the information
from the data base

Form B cont…..

URRAP Referral form

Feedback Form

Achievements to date
• 188 HCWs, PE, non health counsellors, volunteers, data
collectors, trained to use the M & E system including the
data base
• 6,420 people reached (4,561 male; 1,859 female) in
March 09
• 1762 one to one outreach
• 14 MARPS referred by one NGO and accessed HIV
testing services
• 10 tested, 2 HIV positive and referred to CTC

Current Indicators
Indicator Type Type of data collected
Outreach # served/reached
# community events
# communication events conducted
# of radio/TV spots developed and aired
Capacity building # peer educators, Health Care Workers,
counselors trained
Referrals # IDU/MARP referred to HIV services, drop in
centers
Counseling and testing # IDU/MARP counseled, tested, received results
Supervision # of supervision visits conducted
Helpline # of callers provided with HIV/STI/IDU info
Sensitization # of sensitization meetings

Challenges : M &E
• Training of IDU / MARPS outreach workers on using forms
– need regular mentoring on correct use of forms
– Due to concerns about confidentiality unable to utilize names
or unique identifiers codes;( SOLUTION: Juma Ally Juma – we
use the first two letters of each name: JUALJU)
• Health care workers at CTC and VCT sites rarely provide feedback
after referral
• Drug users tend to ask for monetary incentive
• Hard to retain trained former drug users/ on recovery as peer
educators due to relapse
• Limited prevention efforts specifically focuses on drug users due to
secrecy and discrimination
• The M&E tools, indicators and Data base continue to be refined as
the program is implemented and this requires retraining peers

Conclusion & Way forward
• Use of new URRAP electronic database and tools can
be used for other MARPS IPs and potential for use at
national level, this will enable tracking clients through
multiple contacts to demonstrate behaviour change
• ICAP TZ is a strategic partner in developing national
MARPs M&E system
• To develop Standard Operating Procedure (SOP) for
outreach activities hence facilitate a clear link and match
between activities and M&E tools
• Data from outreach activities expected to shed additional
light on the demographic profile and health needs for
MARPs in Zanzibar

• Co authors
Acknowledgement
• IDUs/MARPS, and Peer educators/counsellors
• URRAP implementing partners/Community Leaders
• Zanzibar AIDS Control Program (ZACP)
• Department of Substance Abuse Prevention and
Recovery (DSAPR), Zanzibar
• Ministry of Health and Social Welfare, Zanzibar
• PEPFAR
• Centers for Disease Control and Prevention Tanzania
• Columbia University Tanzania and New York Staff

Thank you