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Guido Dingemans/Jhpiego

HIV and TB

While steady progress has been made in the HIV pandemic, women are still disproportionately affected in many countries where MCSP works, especially adolescent girls and young women. In sub-Saharan Africa, women account for 56% of new HIV infections among adults. The Program is contributing to the global goal of ending the AIDS and TB epidemics by increasing access to prevention, treatment, care and support services. We assist governments throughout the region to ensure that HIV testing and treatment is afforded to women and their children when accessing MCSP-supported maternal and child health services.

In Namibia, MCSP worked to advance the US President’s Emergency Plan for AIDS Relief’s (PEPFAR) Blueprint: Creating an AIDS Free Generation, and USAID’s objectives for the country and the Agency’s global goals to prevent maternal and child deaths. Beginning in 2014, MCSP supported Namibia’s Ministry of Health and Social Services (MOHSS) to strengthen:

  • The continuum of care from households and communities to health facilities by improving and institutionalizing the community health worker (CHW) cadre and the national Health Extension Program (HEP);
  • Access to and uptake of comprehensive, youth-friendly HIV services by priority populations;
  • Programmatic commitment to and emphasis on reaching and supporting young people with HIV services; and
  • Program efficiencies through innovation and greater integration of existing HIV/TB and RMNCAH services, including focuses on nutrition and WASH.

MCSP also supported the MOHSS/Health Information and Research Directorate in the strategic enhancement and integration of the country’s fragmented Health Information System (HIS), and to improve data quality as well as its effective and strategic use for decision-making at all levels.

In Nigeria, MCSP provided technical assistance to US government-funded HIV testing services implementing partners to scale up and evaluate partner notification services (PNS), a highly effective approach to diagnosing and treating a HIV and other sexually transmitted infections. The Program also developed a learning resource package to support facility-based implementation and standardization of PNS in Nigeria. This package included: implementation materials; monitoring and evaluation tools; standard operating procedures; information, education, and communication materials; and tools for ongoing mentorship.

In Haiti, MCSP worked to strengthen the quality of HIV prevention, treatment, care and support services in 42 PEPFAR-supported facilities, and provided HIV testing services in four additional facilities. MCSP focused on supporting the increased efficiency of HIV testing in 42 facilities to better monitor adherence and retention of clients on ART, and prevent treatment failures/resistance to ART. Gender-specific barriers to uptake and adherence to treatment were addressed through ensuring peer education and support are culturally relevant. The Program also supported community-based services – such as distribution of antiretroviral therapy (ART) – with a focus on retention and care for all people living with HIV in MCSP areas.

Key Results

In Haiti:

  • Responded quickly to emerging strategies and priorities in the national HIV program, and brought 46 HIV facilities up to speed on the latest treatment guidelines through technical assistance, training and support to direct service delivery. This included the introduction of “test and start” guidelines, under which 717,010 people were tested and counseled for HIV and 11,643 were placed on or brought back to antiretroviral (ARV) treatment.
  • To bring patients lost to follow-up back to treatment, adapted and implemented an easy-to-use mobile health application that facilitates data collection by the HIV peer educators and CHWs. A total of 276 providers from 25 priority sites were trained to use the mHealth app to track patients, home visits, and distribution of ART at the community level. As a result, 1,294 clients were contacted, 991 were geo-located, 103 who were lost to follow-up were brought back to care, and 1,140 were placed on community distribution of ART.
  • Support to facilities resulted in initiation of viral load testing at all 42 facilities that provide HIV treatment. As of December 2017, 7,886 people living with HIV completed viral load testing, of which 5,018 (64%) were virally suppressed.
  • In collaboration with the National Laboratory of Public Health, implemented a strategy to reduce viral load result turnaround times. By coordinating with facilities to enable providers to receive results electronically, average turnaround time decreased from two months to two weeks.
  • Installed 41 electronic medical records on local servers, which are now available in the 42 PEPFAR-supported sites providing care and treatment. Biometric bio plugins were also provided to record all current and newly enrolled clients living with HIV into the electronic medical record system. Internet access was also provided to these facilities to allow electronic medical records to be functional.
  • To ensure access to services in remote areas of the project’s catchment area, supported the realization of 70 mobile clinics to provide HIV/AIDS, family planning, and maternal and child health services. Through these clinics, staff tested and counseled 6,981 people for HIV and syphilis, and increased ARV enrollment as part of the “test and start” strategy.

In Namibia:

  • Worked with the Ministry of Health and Social Services to increase access to HIV testing services) for hard-to-reach populations in Engela and Omuthiya districts through the National Health Extension Program (HEP).
  • More than 12,000 individuals were tested for HIV by CHWs, resulting in 243 newly diagnosed HIV-positive clients were identified (a 2% HIV positivity rate).
  • Linkages to care in Engela district improved from 68% in March 2017 to 91% in September 2017, and in Omuthiya district from 43% to 86% during the same time period.
  • Developed CHW-specific community-based HIV testing and counseling (CBHTC) training and related job aids, quality assurance frameworks, and monitoring and evaluation systems in preparation for integration of CBHTC into the HEP curriculum and national scale-up of CBHTC (anticipated in 2018 and 2019).
  • To improve HIV treatment adherence and retention in care, supported 27 CHWs to established 17 community-based treatment and care groups in Kavango Region.
  • Supported the MOHSS to strengthen HEP program performance and management through supportive supervision for CHWs and coordination with districts and regions to plan and monitor HEP implementation, and test a peer mentorship approach to strengthen program implementation and reporting in one district in Kavango East.
  • Assisted CBHTC supervisor training in districts rolling out CBHTC.