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“Positive Teas”: Ensuring Adherence with Limited Resources Polejack, L.1, Lima, J. 1, Chagane, H. 2, Lopes, N.2, Ferrão, C.3, Marote, I.4;, Amane, G.5 International Center for AIDS Care and Treatment Programa (ICAP), 1Columbia University Mailman School of Public Health, Maputo, Mozambique, 2Hospital de Dia do Hospital Militar de Maputo, 3Hospital de Dia do Hospital Pediatrico de Maputo, 4Hospital de Dia do Hospital José Macamo, 5Hospital de Dia do Hospital de Mavalane CONCLUSIONS EXPERIENCES TO DATE Since 2004, ICAP has utilized USG PEPFAR funds to support expansion of HIV care and treatment services in Mozambique. This includes providing central technical support to the Ministry of Health (MISAU), support to provincial health departments in 5 provinces and site support to 14 comprehensive HIV/AIDS Day Hospitals. Currently, more than 30,000 patients receive care at these facilities, including more than 10,000 who are on antiretroviral therapy (ART). ART adherence is a complex and multi-dimensional challenge, further complicated by personal, societal and economic factors. MISAU, with ICAP support, conducted a pilot study of factors that interfere with adherence to ART. In this study, the “lack of a support network” was identified as a key obstacle. In response to this lack, “Positive Teas” were launched in 2005 at four Day Hospitals in Maputo. “Positive Teas” are informal monthly meetings for HIV-infected patients, their families and friends, as well as their formal and informal care providers. The “Teas” are designed to offer a safe space for them to share their personal experiences with others who are affected in multiple ways by living with HIV. The “Teas” were designed to help patients and their loved ones understand that HIV treatment is a shared experience. They also help to build relations among patients with their own families, and with families of other people living with HIV/AIDS (PLWHA). The teas provide a safe space to discuss issues that are not often discussed at home, such as their fear, the stigma that many still face, and their insecurities dealing with HIV/AIDS. Sharing their own experience and insecurities with others helps to strengthen their relationships with each other and with their families. Once the patients realize that they are not alone in the way that they feel and the issues that they face, they can work together to find strategies to deal with these issues. At the same time, they develop a sense of belonging to a group. It is also important to include the teams of healthcare providers in the teas. Sitting with the patients in the same circle diminishes any perceived hierarchy between health professionals and their patients, and establishes and strengthens links between them. In the bigger picture, the teas open an important space to bring up the idea of patient’s rights, and involve patients directly in how to improve their own care and for the health teams to learn what is necessary to provide PLWHA with high quality care. In conversations during teas, strong points are discussed, weak points are acknowledged, and patients provide suggestions to the team, so that the weaker aspects can be addressed from the patient’s perspective as well as from a clinical one. As a result of the teas, patient support groups have been formed, and peer educators have been identified. As patients become more involved in their own care, the health team can tailor their treatment, and PLWHA become more empowered and feel in charge of their own lives. The Positive Teas have proved to be an important strategy for patient inclusion in treatment and integration at the day Hospitals. PLWHA participating at Military Hospital teas created a weekly support group, called PFUKA UHANHA (Wake Up and Live!) This group is the first peer educator group working in coordination with the hospital team. They assist in the reception of new patients, in group counseling and in the search for defaulters from their community. The teas have also resulted in weekly patient-support groups in three other hospitals; one specifically aimed at families of PLWHA. To deal with social problems, such as unemployment, difficult access to transport, and food provision, the group from Mavalane Hospital organized a cooperative to generate profit and technical capacity. The patients meet together to teach each other handcraft techniques, with the intention of selling the crafts to generate income to be used by the group. “Positive Teas” offer a significant, positive contribution to HIV treatment. They provide a unique and broad support group environment by including not only HIV-infected patients, but also their family members, friends, clinicians and other care providers. The Teas contribute to build a multi-disciplinary approach to treatment and to empower patients and families by including them as active participants and by valuing them as partners in their care. The informal atmosphere of the Tea improves linkages between clinicians and patients as the difficulties and search for solutions are shared. They offer the potential to provide quality psychosocial care and to achieve high rates of adherence with medications and visits because patients then feel co-responsible for their treatment and are active participants in the Day Hospital flow. Future plans are in development for rigorous evaluation of the effect of the Positive Teas on patient outcomes and patient satisfaction with care. . . WHAT ARE POSITIVE TEAS? BACKGROUND A positive tea requires a large space to accommodate patients, family, friends and the health care team for one hour. Posters are hung at the hospital reception with the date and time. During the month, counselors also tell patients about the tea and ask them to extend the invitation to their relatives and friends. The first tea was facilitated by one counselor/psychologist, but two hospitals (Military and Mavalane), expanded this to include any and all members of the healthcare team who wish to attend. The teas are held in the waiting rooms at the Day Hospitals or in any other available space in the Hospital to capable of providing the space necessary for the number of people who attend each tea. The meetings are opened by the counselors, who explain the objectives. Facilitators work to create a welcoming atmosphere that is non-judgmental. They reinforce the idea that everyone is there to learn together how to live with HIV/AIDS. The tea is a space to share experience and difficulties, talk about feelings, and remove doubts about HIV/AIDS and ART. Normally the counselor presents some that the group will discuss during the tea: Adherence, difficulties patients face in following treatment, fear and stigma, or the difficulties they face on daily basis. Depending on group questions, some professionals may be invited to present specific technical matters, e.g.: TB/HIV co – infection, or ART interaction with traditional drugs. The meetings normally last between one to two hours. During the positive tea at the Pediatric Day, the focus is in relation to the family and the child. Everyone participates: the caregivers, the families and the children themselves. While the caregivers talk to the team, the children receive snacks and play games, but they pay attention to what is being discussed, because everything takes place in the same room. The Positive Teas are free-flowing encounters, and discussion includes questions regarding treatment and difficulties encountered with adherence, such as: lack of food, fear of disclosure and strategies to remember taking the pills. The group problem-solves about ways to overcome obstacles and build a more supportive treatment environment. Snacks are also provided during the Teas. Hospital posters announce positive teas. Children create artwork during Positive Teas held at Maputo’s Pediatric Day Hospital. Positive Teas provide a safe space for HIV-infected patients, their families and friends, as well as care providers, to share their personal experiences about living with HIV. Healthcare providers, counselors, and psychologists participate in the Positive Teas. WHAT ARE THE OBJECTIVES OF THE POSITIVE TEAS? HOW ARE THE POSITIVE TEAS STRUCTURED?

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