The Total Facility Approach: Assessing the Impact on stigma and HIV outcomes

HIV stigma and discrimination in health facilities continue to challenge access to quality HIV prevention and treatment services across the world. The Total Facility Approach (TFA) is an evidence-based HIV stigma and discrimination intervention that has been implemented in health facilities in both Ghana and Tanzania, and has been shown to reduce stigma towards clients and among staff, and increase access to services. This three-year project provides the first opportunity to implement the intervention in Zambia, and to expand it to include Nursing Schools and Continuing Medical Education in Zambia as well as Ghana and Tanzania. If successful, with the support of stakeholders and professional bodies, the TFA will be positioned for scale up.

Expanded Total Facility Approach

Pre-service stigma reduction training for student nurses (designed with, and delivered by, clinical tutors)

In-service training for all staff in a facility

Certifying Continuing Medical Education (CME) to recognize the importance of stigma reduction training and refresher courses in stigma reduction Evidence -generation to assess the impact of the in-service TFA on HIV testing, treatment, and prevention outcomes, and on HIV stigma and discrimination outcomes. Scaling–up: preparing the expanded TFA intervention for scale-up by harnessing stakeholder support and developing a scale-up

Partners: In Zambia, Zambart is the lead on the project. Zambart is working with Macha Research Trust, the Nursing and Midwifery Council of Zambia and the Ministry of Health including provincial health authorities. The selected hospitals for the project are Choma General Hospital and Macha Mission Hospital. The selected nursing schools for the project are Choma Nursing School and Macha Nursing School.

Ghanian partners include: Educational Assessment and Research Center (EARC), NACP and the Ghanian Nursing and Midwifery Council. Tanzanian partners include: Muhimbili National Hospital (MNH) and Muhimbili University of Health and Allied Sciences (MUHAS)

Funder: Bill and Melinda Gates Foundation is funding the Expanded TFA Project (BMGF Grant ID: INV-058082)