Understanding community case workers’ HIV service delivery practices to orphans and vulnerable children in Dar es salaam, Tanzania

Abstract

Introduction: Generally, Tanzania has approximately 1.3 million orphans due to HIV and traditionally orphans are provided with services within extend families in the community. The MoHCDGEC has established a structure to provide services for OVC in the community using volunteers known as Community Case Workers (CCWs). In Tanzania only 52.2% of people living with HIV know their status, and this makes. With this gap in identifying new clients who are HIV positive, linkage for ART initiation for those who are HIV positive, supporting them to adhere to ART and eventually have viral suppression, community support is key and CCWs‘ role and how competent are they is important to establish. Aim of the study: To assess CCWs‘ HIV service delivery practices to OVC in Dar es salaam, Tanzania Methodology: This study is a cross-sectional in design. Data collection used a questionnaire which involved face-to-face interviews with a sample of CCWs. The sampled 414 CCWs providing services to OVC in Dar es Salaam were interviewed during community monthly meetings. Data analysis involved descriptive as well as multivariate analyses. Pearson‘s Chi–square test (for categorical variables) and multivariate analysis were used to assess factors associated with CCWs‘ practices on HIV service delivery. Inference was made at a significance level of 5%. Ethical clearance was sought from MUHAS and permission for conducting the study was sought from RAS and respective DEDs. Participants were required to give a written consent. Results: Findings showed good level of CCWs‘ practices on the three outcomes; SDP on Need assessment (low 3%, medium 76% and high 22%); SDP on Care plan development (low 2%, medium 64% and high 34%) and SDP on Referral issuance (low 0.2%, medium 33.8% and high 65.9%). HIV Service delivery practices is associate with HIV/AIDS knowledge; CCWs with the highest HIV/AIDS knowledge are likely to have the high level of practices on Need assessment (aOR=2.50, 95% CI 1.40-4.46). And CCWs belonging in the highest HIV/AIDS knowledge tertile were 3.15 times more likely than those in the lowest knowledge tertile to perform higher in terms of referral issuance (aOR=3.15, 95% 1.82-5.47) Conclusion and Recommendation: A major predictor of HIV service delivery practices is CCWs HIV/AIDS knowledge; the higher the HIV/AIDS knowledge the better the HIV Service delivery practices outcomes. Other associated factors are sex, supportive supervision, case load and area of residence