In 2015, we made Chiyembekezo for In Tune for Life and the Tingathe Outreach Programme, at Baylor Children’s Foundation Malawi funded by USAID.
Research and Data (Source: In Tune For Life)Early data from qualitative research performed by the Tingathe program suggested that communication from health care providers to patients regarding HIV testing and ART has been inconsistent and at times erroneous likely due to lack of qualified clinical staff coupled with the increase in clinical burden. In combination, these have contributed to poor linkage to ART care and poor treatment outcomes for both mothers and their infants.
In response to this need, In Tune for Life in partnership with Tingathe, has piloted the use of an innovative video program, which aims to provide clear and consistent PMTCT and pre-ART counselling to pregnant and breastfeeding mothers without the need for a counsellor to be present. The film will be used during the critical ‘teachable moment’ immediately following a positive HIV diagnosis, before they begin treatment on the same day.
The film named Chiyembekezo (meaning ‘Hope’ in Chichewa) tells the story of a pregnant woman’s journey from diagnosis to disclosure. The main character Alinafe receives a HIV positive diagnosis during her ANC care and we follow her through her anxieties about her health and protecting her baby. A nurse and close friend encourage her to disclose her status and through their reassurance, we see Alinafe empowered in her relationship with her husband and informed about taking her ART for life.
We have utilized a community participatory approach in creating the film:
A series of focus group discussions were conducted with the target group and clinical advisors to establish the key messages to be included in the script.
An advisory group of frontline health workers and members of the target group was established to consult regularly on the script. A total of eight drafts of the script were edited by the advisory group.
The production process involved recruiting local actors and filming in a semi-urban area of Lilongwe. Multiple edits of the film received review by key stakeholders and necessary corrections were made.
Pilot findings demonstrated an overall positive response to the film. Critical areas of PMTCT knowledge such as EID testing, exclusive breastfeeding and taking ART for life were shown to improve among a significant number of participants after being exposed to the film with a 32% increase in correct answers from Test A to Test B.
The qualitative psychosocial response data highlighted that participants felt encouraged and comforted by witnessing the story of a character in their position. Participants discussed that they would have felt more empowered to disclose their status if they had watched the film straight after testing.
Focus group discussion quotes:
‘I would have been more likely to accept my status after watching the film’
‘After watching the film, I would have been encouraged to disclose to my husband and take treatment because it shows the end result can be ok’
‘If my husband watched the film, he would be much more likely to come for HIV testing’
‘It will help us a lot because it has all the essential knowledge. I would recommend highly that it should be used in counselling sessions’
Ministry of Health counsellors felt that the film would improve their pre-ART sessions, as it is a refreshingly new way of delivering information that would capture the patient’s attention.
The film has now been approved by the Malawian Ministry of Health and is being implemented in government clinics and hospitals in Central and South East Malawi.