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Friends in Global Health (FGH) actively supports the coverage of Pre-exposure prophylaxis (PrEP) services for adolescents and young adults in Zambézia Province

jordahl1 — Thu, 08 Feb 2024 15:47:17 +0000

Friends in Global Health (FGH) actively supports the coverage of Pre-exposure prophylaxis (PrEP) services for adolescents and young adults in Zambézia Province jordahl1 Thu, 02/08/2024 - 09:47 RSS:

FGH Communications Team (in-country)

“I took the initiative to adopt PrEP to avoid contracting the HIV virus.” Arlinda Wilson

Arlinda Wilson delivers a health lecture to young women in the Micajune neighborhood, Quelimane District.

Arlinda Wilson, a 21-year-old resident of the Micajune neighborhood, Quelimane District, is one of the 23,445 adolescents and young adults who benefited from Pre-Exposure Prophylaxis (PrEP) HIV prevention services in Zambézia Province during the reporting period (Q1 COP23).

In 2022, with the support of her mother, Arlinda applied for training as an FGH supported Prevention Champion volunteer. Her role involves identifying adolescents and young adults who are victims of gender-based violence (GBV), as well as those who are eligible for PrEP, and referring them for services. She delivers community lectures and supports the organization of meetings involving adolescents, young adults, and community and religious leaders to discuss issues pertaining to GBV, HIV prevention, care, and treatment.

Arlinda is allocated as a Prevention Champion to the Quelimane Secondary School and the 4 de Dezembro Health Facility. She also refers her clients to other health facilities, primarily the FGH-supported Micajune Health Facility, which is close to her home.

“I share my experience with young people who are the same age as me, addressing similar fears, challenges, or concerns, turning negative experiences into learning opportunities.”

Though some reject her message, Arlinda understands that persistence is critical for demand creation:

“At times, when I encounter difficulties in supporting young people, I seek assistance from the School Health Corner counselors and nurses at the health facility, who have been very helpful.”

Having volunteered for nine months, Arlinda has already referred more than 50 adolescents and young adults to PrEP services.

According to existing Ministry of Health guidelines, PrEP is offered to individuals 15 years or older who have a negative HIV test result and who are at high risk for HIV infection. Arlinda achieves better results in her activities at the beginning and end of the school year because students are usually more relaxed, allowing her to conduct lectures in classrooms, resulting in more referrals to health facilities.

Initially, PrEP services were provided at only 18 health facilities in Zambézia Province. Over the past five years, with the support of FGH and funding from PEPFAR, PrEP services have been expanded to a total of 129 health facilities, including to an additional 35 health facilities in Q1 COP23.

Aguinalda Velasco, a 21-year-old adolescent, accompanied by prevention champion Arlinda Wilson, decided to go to the 4 de Dezembro Health Facility to get an HIV test after attending a community lecture.

A total of 160 Prevention Champion volunteers actively contribute to PrEP demand creation activities, reaching 32,663 adolescent and young adult PrEP beneficiaries in Zambézia Province during Q1 COP23, of which 23,445 (72%) were adolescent girls and young women. Additionally, 854 healthcare providers, 1,279 lay counselors, and 2,022 community actors were trained in PrEP, communication skills, and human rights/advocacy-based packages to enhance provider-patient interactions and the overall quality of PrEP services.

Adolescents and young adults, 10 to 24 years of age, are considered by FGH as a priority population for HIV prevention initiatives during COP23, with adolescent girls and young women being the highest priority due to their specific vulnerabilities.

The partnership between FGH and provincial health authorities, with funding support from PEPFAR, continues to play a critical role in reducing HIV transmission in Zambézia Province.

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Pre-exposure prophylaxis (PrEP) for Pregnant Women: An effective strategy for achieving elimination of mother-to-child HIV transmission

jordahl1 — Tue, 31 Oct 2023 17:31:53 +0000

Pre-exposure prophylaxis (PrEP) for Pregnant Women: An effective strategy for achieving elimination of mother-to-child HIV transmission jordahl1 Tue, 10/31/2023 - 12:31 RSS:

FGH Communications Team (in-country)

“PrEP helped me envision a brighter future for my son. Without hesitating, I made the choice to embrace it. I will do whatever it takes to ensure my baby is born healthy,” Jolinda Davane, Morrumbala District, Zambézia Province.

Jolinda Davane and her husband, Chapo Saiconde, shared their story in the Morrumbala District Hospital UATS (Unidade de Aconselhamento e Testagem em Saúde), after their prenatal appointment.

Jolinda Davane, a vibrant 20-year-old woman living in the 25 de Setembro neighborhood in Morrumbala District, embarked on one of life’s most beautiful journeys – motherhood. She is nine months pregnant and had recently received the wonderful news that her HIV test result was negative.

Jolinda knew her husband, Chapo Ernesto Saiconde, has been living with HIV and that he was healthy with an undetectable viral load. Still, when she learned she was pregnant, anxiety and insomnia consumed her. The fear of potentially transmitting HIV to her baby tormented her every day.

Amidst the uncertainties, Jolinda and Chapo decided to take action. One Tuesday morning, they visited the Morrumbala District Hospital for their first prenatal appointment. While Jolinda met with the healthcare provider, her husband waited patiently in the courtyard. During the appointment, the nurse invited Chapo into the room and offered both of them an HIV test.

Jolinda's face lit up when she received the news that her test was negative. “I accepted the test and I jumped with happiness when I was informed that my HIV test result was negative. My husband, who was already aware of his HIV-positive status, shared this information with the nurse. He has been living with HIV since he was born.”

What followed was a life-changing moment for Jolinda. The nurse introduced her to a medication that could reduce the risk of HIV transmission to both her and her baby. With overwhelming relief, she embraced the opportunity to start pre-exposure prophylaxis (PrEP).

“The nurse explained to me how to take the medication and that I could take it to reduce the risk of getting HIV, and also protect the baby from the virus. This information took all the anxiety away and I did not hesitate to accept taking PrEP.”

Leaving that appointment, Jolinda’s heart was filled with dreams of a healthy future for her child. She exclaimed, “Since that day, everything has changed for me. Now, I eagerly anticipate the birth of my first child.”

Chapo became Jolinda’s unwavering supporter, ensuring she never missed a dose of PrEP. He knew that this decision was critical for their child’s health, and together they forged ahead with unwavering determination.

“When my wife was advised to start PrEP, I supported the decision because I knew that the chances of our child being born healthy had increased. I take my HIV pills every day at the same time with my wife, and so it is very easy to remind each other. The fact that I was born with HIV does not mean that my child must also be born with it. This is the information I hear in all of our appointments at the health facility.”

Joalinda Davane, a few minutes after leaving her 9-month prenatal appointment at Morrumbala District Hospital.

According to nurse Joana Almeida, “After receiving the pregnant woman [at the appointment], we always advise her to take an HIV test and we explain the risks of not taking the test. If the test is positive, the woman is advised to start ART following the Ministry of Health “Test & Start” strategy. When the woman initiates ART, the possible adverse effects of the medication are explained. The important thing is to stop the replication of the virus in the body. For women who come without a partner and test positive, we invite the participation of the partner. If the couple is positive after testing, we advise the couple to start taking ARV medications. The partner is transferred to ART services and the woman continues receiving assistance until the ninth month. We follow the pregnant woman so that the delivery takes place at the health facility, reducing the risk of vertical transmission of the virus to the baby.

Now, with PrEP, we also protect the babies of HIV-negative pregnant women, whose partners live with HIV, or are at high risk. They receive PrEP during pregnancy, delivery, and lactation.”

Jolinda Davane is one of 2,280 pregnant women who have benefited from PrEP during the fourth quarter of COP22 in Zambézia Province. This powerful strategy has given women hope and protection against HIV vertical transmission. With funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through CDC, VUMC/FGH supports the Zambézia Province Health Authorities in the provision of HIV services at 149 health facilities, 97 of which offer PrEP services.

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FGH Employee Highlight: Health Counselor Evaristo Ricardo reflects on FGH’s commitment to the LGBTQIA+ Community

jordahl1 — Tue, 03 Oct 2023 14:47:23 +0000

FGH Employee Highlight: Health Counselor Evaristo Ricardo reflects on FGH’s commitment to the LGBTQIA+ Community jordahl1 Tue, 10/03/2023 - 09:47 RSS:

FGH Communications Team (in-country)

Adapted from the special June 2023 edition of FGH Breves, the official newsletter of Friends in Global Health, in celebration of Pride Month.

This June, FGH celebrated Pride Month and its continued support of the LGBTQIA+ community in Mozambique. FGH promotes social equity and the reduction of stigma and discrimination against LGBTQIA+ people as a vital part of the fight against HIV/AIDS.

Evaristo (Eva) Ricardo is a 27 year old resident of Mocuba, a rural district in Zambézia Province. He has been an FGH Health Counselor for three years and is a proud member of the LGBTQIA+ community.

In his adolescence, he discovered that he had a different sexual orientation, identifying strongly with his feminine side. Being the child of pastors, he initially sought spiritual help, believing he was possessed. As an adolescent, Eva experienced discrimination at school and suffered rejection at home due to his sexual orientation. Through LAMBDA, an LGBTQIA+ advocacy association in Mozambique and FGH partner, he met other people of different sexual orientations and for the first time he felt comfortable in his identity.

For Eva, identifying as LGBTQIA+ in Zambézia Province comes with challenges. There are still obstacles in accessing employment and equal rights. But things are changing. “[Being gay] means being someone who draws attention and attracts the gaze of curious people wherever they go. There are still those who look at me with distrust. However, I must say that in the cities of Quelimane and Mocuba, more respect for us is already evident.”

Trained in Preventive Medicine, Eva has been working as an FGH Health Counselor assigned to Mocuba Health Center for the last three years. Prior to arriving in Mocuba, he worked in the provincial capital of Quelimane, at the Sangarivera Health Center. “When I arrived [in Mocuba] to work, it was a surprise for all my colleagues. They did not expect to have a gay colleague. But they quickly welcomed me and I am very happy with the work I do.”

In addition to the supportive work environment, Eva praises FGH’s commitment to the implementation of HIV health services created specifically to assist members of the LGBTQIA+ community. “In the past, it was difficult to access health services. The inclusion of men who have sex with men (MSM) as a key population is very important. Receiving [specialized] attention in health sector initiatives represents greater access to care and treatment, including for HIV. We need to increasingly create a welcoming environment for [LGBTQIA+ patients] to feel free to talk about all their health concerns.”

In 2022, FGH conducted training for improved interpersonal communication between providers and patients which included a component on improving the quality of care for LGBTQIA+ patients. A total of 510 health care providers were trained from 35 health centers across 17 FGH-supported districts in Zambézia Province.

Pride Month has special meaning to Eva. “June represents joy for me. It’s the month of celebration and it serves to raise awareness in the community and the world about respect for diversity. This is the month when we talk about the importance of respecting the diverse sexuality of every person and moving towards a world without discrimination.”

FGH Health Counselor Evaristo Ricardo

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Reintegration Campaigns: Restoring Health Services After Cyclone Freddy in Zambézia Province

jordahl1 — Mon, 31 Jul 2023 18:26:15 +0000

Reintegration Campaigns: Restoring Health Services After Cyclone Freddy in Zambézia Province jordahl1 Mon, 07/31/2023 - 13:26 RSS:

FGH Communications Team (in-country)

“Because of antiretroviral treatment, I'm still alive and able to take care of my children. I want to advise everyone in HIV care and treatment to follow the recommendations of their healthcare providers.” Amélia Francisco, Namacurra District.

Amélia Francisco is a thirty-six-year-old single mother of four living in Namugule, Namacurra District. She has been on antiretroviral therapy (ART) since 2013. Amelia's first child is nineteen years old and also on ART. Her younger three children, ages fifteen, eleven, and eight, are all HIV-negative. She told us, “Fortunately, the other three children tested negative for HIV because when they were born, I was already on ART, and during the pregnancy I decided to be adherent, to never abandon my prenatal care and HIV consultations.”

On March 11, 2023, Amélia’s life, along with the lives of over 200,000 other people in Zambézia Province, was severely affected by the landfall of tropical Cyclone Freddy. With winds reaching 148 kilometers per hour and heavy rainfall of up to 300 milliliters within 24 hours, the cyclone left a trail of destruction in its wake. Essential infrastructure such as roofs, roads, electricity, and telecommunication networks suffered severe damage.

FGH employees Dr. Tánia Mulhanga and counselor Isidro Ossufo conducting an HIV consultation with Amélia Francisco at a health fair in Dualia, Namacurra District.

The health facility where Amélia received services was among many that were severely affected by the cyclone. The roof was damaged and maternity care and HIV services were temporarily suspended.

Amélia’s house in Namugule was destroyed by the cyclone, forcing her family to temporarily relocate to a different neighborhood in Mucucunho. Amélia focused her efforts on rebuilding her house, ensuring that her children have a place they can call home. The rebuilding period was challenging and Amélia had to make many sacrifices. As for many people dislocated by the cyclone, Amélia did not have the time or transportation to seek healthcare. She missed her routine appointment at the health facility and ran out of her ART. Amélia’s treatment was interrupted for two months.

The emergency caused by Cyclone Freddy resulted in the highest level of treatment interruption in a single month in more than five years at FGH supported health facilities. Amélia was just one of the 25,175 patients in Zambézia Province who experienced treatment interruptions in April 2023, representing 7% of the total number of patients currently receiving ART. But FGH and local health authorities worked quickly to address the challenges faced by patients and by the end of June, the number of patients active on ART had increased to 361,352, returning to the pre-cyclone levels. While Amélia was still working to rebuild her house, she heard about an FGH ART reintegration campaign taking place in the Dualia neighborhood, near her temporary housing in Mucucunho. Amélia attended a health fair organized as part of the reintegration campaign. There, she received a clinical consultation, viral load testing, and a supply of her ART.

Amélia told us about the value she sees in health fairs conducted in the community, “They are very important and beneficial for us because many people have difficulties reaching the health facilities. We live very far from the health facility and sometimes we need to pay for transportation, and we don’t have money for that. The fair also helps those who missed the opportunity to pick up their ARVs. They have an opportunity to return to care. That’s what happened to me.”

Amélia Francisco having a blood draw for viral load testing at a simplified mobile clinic at a health fair in Dualia, Namacurra District.

Work to repair the damaged roof of Amélia’s local health facility was initiated with support from Friends in Global Health (FGH). In neighboring Quelimane District, repair work has already been completed. Francisco Américo, the Director of the 17 de Setembro Health Facility in Quelimane told us,

“Thanks to the efforts made by FGH, it was possible to replace the roof of various buildings of the health facility destroyed during Cyclone Freddy, which allowed the resumption of services that had been suspended.”

To respond to the emergency caused by Cyclone Freddy, FGH supplemented PEPFAR funding with funding from the Embassy of Switzerland in Mozambique, and Millennium BIM bank, enabling roof repairs at 41 supported health facilities and allowing the resumption of services that had been temporarily suspended.

FGH supports provincial health authorities to provide HIV and TB services at 149 health facilities in Zambézia Province with PEPFAR funding through the Centers for Disease Control and Prevention (CDC).

Amélia Francisco drawing water from the well at her home in Namugule.

In response to Cyclone Freddy, patient reintegration campaigns were activated, complementing home visits and community ART distribution by healthcare providers. These campaigns utilized lists of patients meeting treatment interruption criteria, organized by neighborhood. Invitations were delivered to patient homes by FGH community healthcare workers, while community leaders were engaged to ensure widespread participation. The campaigns provided comprehensive services, including clinical consultations, viral load testing, psychosocial support, ART dispensation, prophylactic treatment (such as TB preventive therapy), and youth-friendly services. Improved infrastructure and community outreach activities significantly contributed to the restoration of health services in Zambézia Province.

The emergency caused by the cyclone had a significant negative impact, but the rapid response provided by FGH and local health authorities enabled the reintegration of individuals to ART services and allowed efforts to control the HIV epidemic in Zambézia Province to return to normal as quickly as possible.

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Continuing HIV Services in the Aftermath of Cyclone Freddy

jordahl1 — Fri, 05 May 2023 18:33:58 +0000

Continuing HIV Services in the Aftermath of Cyclone Freddy jordahl1 Fri, 05/05/2023 - 13:33 RSS:

FGH Communications Team (in-country)

“Thanks to the health providers that were working at the shelter at Eduardo Mondlane Secondary School, it was possible to have my antiretrovirals, continue my treatment and continue to live a healthy life,” Rita Diogo, who lost her home to Cyclone Freddy.

Rita Diogo holds up her ARVs inside her home.

Rita Diogo is a thirty-eight year old resident of Micajune, a neighborhood in Quelimane City, the provincial capital of Zambézia Province. She has been receiving antiretroviral therapy (ART) since 2015. When Cyclone Freddy made landfall on March 11th, it hit approximately 30 kilometers from Quelimane. Winds with a maximum speed of 148 kilometers per hour resulted in widespread damage to homes, as well as the city’s electrical grid and telecommunication network. Micajune was one of the neighborhoods most severely affected by the storm. Diogo’s home, along with the homes of many of her neighbors, were completely destroyed by the strong winds and torrential rains. She lost all her belongings, including her antiretroviral medications.

The local government established several temporary shelter centers in schools and other public buildings to accommodate displaced persons. Rita Diogo knew the importance of continuing her ART, even in the midst of a natural disaster.

“My house was destroyed by the Cyclone, and I had to join my neighbors who went to Eduardo Mondlane Secondary School to find shelter, care, and food…Everything was left behind, including my medicine. I was desperate because my life depends on this medicine... When I arrived at the shelter, a health team came and said that we could receive medical assistance for various diseases, and we could pick up our medicine ... I was so happy!” she told us, smiling brightly.

Free from worrying about how she will get her medication, Diogo is focused on rebuilding her home with her husband, with support from their neighbors in Micajune.

Friends in Global Health (FGH), in coordination with the Zambézia District Health Authorities, supported twenty-four shelters in Quelimane and neighboring districts in the immediate aftermath of Cyclone Freddy. Support included the mapping of the most urgent health needs, and the implementation of mobile health brigades within each shelter. A total of twenty-three clinicians were allocated to the mobile health brigades, twenty-one of which were hired by the District Health Authorities with FGH support. A total of twenty FGH lay counselors were also allocated to the shelters. These personnel provided medical assistance to the individuals and families housed in the shelters, ensuring the continuation of HIV services.

As a result of flooding caused by Cyclone Freddy, which cut off access to running water, sanitation, and hygiene services, cholera cases began to rapidly increase, particularly in Quelimane City. Quelimane District Health Facilities were inundated by patients seeking emergency care for water born illnesses, including over 12,000 cholera cases confirmed in just one month.

Regina Caetano and her daughter after receiving water purifier from community health activists.

Regina Caetano is a thirty-seven year old mother of five children and a resident of Micajune. While her house survived the cyclone, her family was affected by contaminated water. She explained to us,
“In my house there is a common tap, but the water was cut off in Quelimane and now I have to fetch it from a well. I had a situation where my children had problems with diarrhea, followed by vomiting.”

In response to the cholera outbreak, FGH and the Provincial Health Authorities trained 1,309 FGH volunteers, including Peer Educators, Male Champions, Pediatric Mentor Mothers, MCH Mentor Mothers, Adolescent Mentors, and Cough Officers, to integrate cholera prevention messages into their routine HIV-related home visits. Volunteers also began distributing bottles of chemical water purifier. Regina’s household received a visit from one such FGH volunteer:

“The community volunteer explained to me how I can use this water purifier to correctly treat my water to prevent cholera. It makes me happy to know that I can protect myself and my family. I advise everyone to treat their water to avoid illness, and always to wash their hands.”

By the end of March, VUMC/FGH was supporting 358,034 individuals on ART in Zambézia Province with PEPFAR/CDC funding. FGH support goes far beyond the strengthening of HIV services. FGH quickly recognized the need to adjust HIV service provision to the changing post-disaster conditions and to integrate routine support with emergency response to disease outbreak. In Quelimane, the response included the distribution of 16,319 bottles of water purifier by FGH supported volunteers in a period of just 15 days.

Community health activists hold up bottles of water purifier before distribution in Micajune.

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Teenagers in Mozambique Participate in Countrywide COVID-19 Vaccination Campaign

ridingkm — Fri, 24 Mar 2023 15:39:47 +0000

Teenagers in Mozambique Participate in Countrywide COVID-19 Vaccination Campaign ridingkm Fri, 03/24/2023 - 10:39 RSS:

https://www.cdc.gov/globalhealth/stories/2023/teenagers-in-mozambique.html

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FGH supports expansion of PrEP services in Zambézia Province

ridingkm — Wed, 01 Mar 2023 22:33:31 +0000

FGH supports expansion of PrEP services in Zambézia Province ridingkm Wed, 03/01/2023 - 16:33 RSS:

FGH Communications Team (in-country)

“The first time I heard about PrEP was through Quelimane FM radio. Days later, I received a visit at my house from a Prevention Champion who also talked to me about it and explained a bit more of what PrEP was. After the explanation he gave me about PrEP, he invited me to go to the health facility where I could talk with the SAAJ nurse for more information and understand if I was eligible to receive it.” Amélia Vasco is a 23-year-old living in Quelimane District and a new beneficiary of PrEP (Pre Exposure Prophylaxis) services.

Amélia receives PrEP from MCH nurse, Regina Fernando.

A total of 10,202 people initiated PrEP at FGH-supported health facilities during the reporting period (Q1 COP22), an impressive 69% increase compared to the prior reporting period (6,046 in Q4 COP21).

In 2015, the World Health Organization recommended PrEP as an additional prevention option for people at risk of HIV infection and it was first implemented in Mozambique in October 2017. PrEP is part of a combination prevention strategy being implemented in Mozambique with the objective of reducing new infections and reaching epidemic control by 2030.

In Zambézia Province, PrEP services were first offered in March 2018 in 18 health facilities in 10 districts. The number of health facilities offering PrEP gradually grew as part of a coordinated effort made by the provincial health authorities with the support of FGH. Recently, an additional 26 supported health facilities began offering PrEP, so that by the end of 2022 (Q1COP22), FGH was providing direct support to PrEP services at 92 health facilities across 18 districts.

PrEP is offered to individuals 15 years of age or older who have a negative HIV test result and are at a higher risk of being infected by HIV, including serodiscordant couples, adolescents and young people between 15-24 years of age, key populations (men who have sex with men, female sex workers, prisoners, and people who inject drugs), as well as pregnant and lactating women, and men older than 25 years of age in settings with a high HIV prevalence.

Amélia returns home after her PrEP consultation.

PrEP access among adolescents and young people between 15-24 years of age, such as Amélia Vasco, has increased in FGH-supported health facilities. Sixty-one percent of the 10,202 people initiating PrEP in Q1 COP22 were adolescents and young people, and 73% initiated PrEP in health facilities within FGH-supported districts implementing the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) strategy. In coordination with the FGH DREAMS team, a referral standard operating procedure (SOP) has been implemented to ensure that eligible Adolescent Girls and Young Women (AGYW) were referred from School Health Corners to receive health testing services within the Adolescent Friendly Services sector (SAAJ) at the health facility and offered PrEP. Prevention Champions, AGYW volunteers that work at schools in coordination with the counselors stationed at the School Health Corners were trained on the PrEP demand creation package to ensure improved referrals from schools to SAAJs.

Regina Fernando, Maternal and Child Health (MCH) Nurse assigned to the Micajune Health Center, is satisfied with the current level of acceptance of PrEP by adolescents and young people, which was a real barrier when the service was first introduced at that health facility. “In the beginning, there was a lot of fear on the part of young people who came to seek our services. Whenever we talked about PrEP, they were worried about having to take a medication that resembles the medication for people living with HIV while they were not sick, and of having adverse effects from the medication. But thanks to the awareness made by health providers at the health facilities and Prevention Champions in the communities through lectures, people’s mentality in relation to PrEP is changing, and today they accept it more easily.

Another aspect that has helped a lot in this change of mentality is the dissemination of messages that talk about PrEP through radio stations here in the city of Quelimane and the distribution of leaflets and posters with messages about PrEP, which help people find answers to their main doubts about PrEP in the privacy of their homes.”

Aware of the importance of taking PrEP, Amélia explained that:

“Even after having received information about what PrEP is and who should take it, I was afraid to take the service, as I was afraid that my family and friends would confuse the medication with HIV treatment. But during the conversation with the nurse, she explained to me in more detail about how PrEP works and I analyzed my own situation. My partner works far from home in another district, and I don't know what he's doing when he´s there, which made me very insecure. That's when I made the decision to protect my health and follow the recommendations I received from the nurse and prevention champion to start PrEP.”

In Q1 COP22, to respond to the need to expand PrEP, FGH worked in coordination with the provincial health authorities to support the training of 41 clinical providers and 42 lay counselors from 26 health facilities in the districts of Ile, Mopeia, Morrumbala, Inhassunge, Gurué, Mocubela, Molumbo, and Pebane. Implementation of PrEP services in these 26 HFs followed shortly thereafter. In addition, refresher trainings were conducted at the health posts located in the following prisons: Cadeia Civil Milange, Cadeia Civil Mocuba, and Cadeia Civil Gurué.

Amélia wanted to make a recommendation for other adolescents and young people, based on her own experience with PrEP: “I've been taking PrEP for about 3 months now and I'm living my life with more confidence because I know I'm in control of my health and I'm protected from HIV. For other young people who are in a situation like mine, I would like to encourage them to go to the nearest health facility to find out about their health status regarding HIV, and if they are eligible, to start PrEP. Also remember that taking PrEP does not mean that we should stop using condoms, because they protect us from other sexually transmitted diseases and unwanted pregnancies.”

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Mobile Brigade Services Improve Viral Load Coverage in Zambézia Province

ridingkm — Thu, 01 Dec 2022 14:43:38 +0000

Mobile Brigade Services Improve Viral Load Coverage in Zambézia Province ridingkm Thu, 12/01/2022 - 08:43 RSS:

FGH Communications Team (in-country)

Sónia in a consultation with nurse Estefânia Sebastião Carlos at the Inhangulué Health Center

Sónia Miguel is a 36-year-old mother of five and a smallholder farmer. Daily work in her fields limits her ability to seek HIV services from the closest health facility, 12 kilometers away. Recently, she missed a clinical consultation where she would have had a viral load (VL) test performed. One week after she missed her appointment, Sónia received a visit from a Peer Educator.

“I know I have to get a viral load test every year, but I didn't know the exact date. A week after I missed my medication pickup at the health facility, I received a visit from a Peer Educator who informed me that there was going to be an opportunity to join a Mobile Brigade and to be able to take care of my health,” Sónia told us.

The Peer Educator told Sónia that this was an opportunity for her to receive a clinical consultation and to have her blood sample drawn for viral load testing. The Mobile Brigade is a community outreach service providing a wide spectrum of health services to the general public, including HIV prevention, care and treatment services. In Zambézia Province, through the support provided to clinical officers and community health workers, FGH has been strengthening demand for Mobile Brigade services among individuals who have missed the opportunity to perform a viral load test or have missed an antiretroviral treatment (ART) clinical appointment. FGH clinical implementation teams support the provision of services performed by clinicians from nearby health facilities.

Sónia and her husband, Ezerino, in front of their home.

Cremildo Gove, Clinical Officer of a Mobile Brigade in Quelimane District explains, “This activity is very positive because we are able to collect viral load samples from many patients who miss their appointments. We are also able to dispense medication to patients who had interrupted treatment. It is very productive, it helps patients know what their viral load result is and to continue on ART.”

Mobile Brigades have been implemented in health facilities with low viral load coverage. The process begins with a community mobilization exercise that engages faith-based and community leaders from surrounding areas, to ensure acceptance and large-scale participation. During the event, services are provided in space provided by the community, either in buildings, tents or in the open-air using screens and partitions to ensure patient confidentiality.

Sónia Miguel discovered she was living with HIV in 2017 when she became seriously ill. She suffered from headaches, diarrhea, and generalized body weakness. With the support of health providers, she commenced ART. Her last viral load result sample, collected by an FGH-supported Mobile Brigade, was undetectable.

Sónia washes dishes at her home.

“I feel normal. I can go to the field, wash the dishes, and I feel good because my result was undetectable. I will not interrupt treatment,” she told us.

To ensure high viral load testing coverage among ART-treated individuals, FGH designed a set of interventions that include the following:

Mobile Brigades as described above.
Simplified Mobile Clinics through 254 clinical service providers, who provide ART, TB preventive treatment (TPT), clinical consultations, adherence counseling and viral load sample collection at the homes of individuals interrupting treatment.
Use of the Electronic Patient Tracking System (EPTS) to prioritize patients with pending viral load tests for home visits, inviting them to a Health Facility, to a Mobile Brigade, or having a clinician visit them to offer Simplified Mobile Clinic services.
A total of 61 phlebotomists were hired through sub-agreements that FGH established with district health authorities and allocated to 59 supported Health Facilities to increase the number of viral load sample collection points and reduce patient wait times.
Health Communications activities, which during Q4 COP21, stressed the importance of viral load testing and the Undetectable=Untransmittable (U=U) message through 34 theater performances, and radio spots that were aired 1,279 times at community radio stations, small group dialogues, and community talks.

As a result, in Q4 COP21, a total of 245,944 adult and pediatric ART-treated individuals had a viral load result documented in their patient medical record during the past 12 months, representing a 13.3% increase in viral load testing volume when compared to Q3 COP21. This represents 76.4% of viral load testing coverage of individuals eligible for a viral load test at HFs supported by FGH in Zambézia Province, an 8% increase when compared to Q3 COP21 performance.

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Cervical Cancer Screening brings hope to HIV-positive women in Zambézia

ridingkm — Fri, 01 Jul 2022 14:48:05 +0000

Cervical Cancer Screening brings hope to HIV-positive women in Zambézia ridingkm Fri, 07/01/2022 - 09:48 RSS:

FGH Communications Team (in-country)

Hélia Rudofo Paulo at home organizing her kitchen.

“I was not the same person. I was uneasy because it was something that bothered me deeply.
I did not know what [cervical cancer] really was, but after the treatment, after the care that the nurse gave me, thank God everything went back to normal. I feel like a new person.”
Hélia Rudofo Paulo

Hélia lives in a small, crowded house in central Quelimane City. Hélia makes a living by selling small charcoal bundles outside her house. She has three children, a seventeen-year-old girl and two boys, twelve and seven. Hélia has been on antiretroviral therapy (ART) since 2017. None of her children are HIV-positive.

Rudofo Paulo at a follow-up cervical cancer screening consultation with Maria Alfinete

During one of her ART follow-up visits at the 4 de Dezembro health facility in Quelimane, a lay counselor noticed Hélia was having pain in her pelvic area, as well as other symptoms. The lay counselor referred her for Cervical Cancer Screening (CCS), where pre-cancerous lesions were seen on examination.

“When I went there, they told me that I had a small problem and that they would give me a paper to go to the Central Hospital," explained Hélia. After the consultation, Hélia completed the recommended treatment. Hélia adds, with noticeable relief, that after finishing her treatment “I didn't suffer any more pain.” She was able to return to her normal life.

If not diagnosed early, the consequences of cervical cancer can be very serious. Maternal and Child Health Nurse (MCHN) Maria Alfinete explains, “It can reach the point where a woman can no longer take care of her house because she is so sick. She doesn't go to work; she may even die…Her children will be without a mother.” Alfinete has been an MCHN and Quelimane District focal point for the Prevention and Control of Cervical and Breast Cancer (CACUM) program at the 4 de Dezembro Health Facility since 2016.

Dr. Belito Castolino analyzing Biopsy Results.

Belito Castolino is a health technician working for Friends in Global Health (FGH) with the responsibility of coordinating the operationalization of the support FGH provides to the Provincial Directorate of Health in Zambézia (DPS-Z) for the implementation of the CACUM program. According to Castolino, FGH prioritizes cervical cancer screening as an important part of its HIV Prevention and Care & Treatment program. The human papillomavirus (HPV), which can cause cervical cancer, “…sets in quickly in women with immunodepression, that is to say, the probability of getting cancer is higher because their immunity is weak.”

Early detection is very important as Castolino explains, "When cancer reaches the later stages, it can be irreversible, and it can kill.”

However, this does not have to be the case when diagnosed early. “Women can save themselves from getting cancer when they get early treatment for precancerous lesions. For this reason, we are working hard towards screening as early as possible,” Alfinete adds enthusiastically.

Thanks to FGH and the efforts of health workers in the field, increasingly, more HIV-positive women have been screened for cervical cancer, and those with abnormal/pre-cancerous lesions have been referred for care in a timely fashion so that they can receive the care they need.

Such results derive from the productive collaboration between FGH and DPS-Z. In the words of the Director of the Obstetrics and Gynecology Department at Quelimane Central Hospital (QCH), Dr. Equibal Muanaria, the collaboration is very strong “…because FGH can provide us materials that we need for our operation, specifically equipment for electrocoagulation, printed materials like patients’ forms, lockers where we can keep all filled forms, and materials that we need to use when screening as well as in the treatment of precancerous lesions.”

Additionally, “FGH allocated nurses and counselors to our CCS and treatment of precancerous lesions service.” Moreover, FGH provides support for the referral of women with pre-cancerous lesions for treatment from the peripheral HFs to the reference centers, and support in making appointments to reduce the delay in transportation from their places of residence to the HFs.

From April to June 2022 (Quarter 3 COP21), 429 women were screened for cervical cancer at the 4 de Dezembro health facility in Quelimane, corresponding to 72% (597) target achievement for the reporting period. Out of the 429 screened women, 24 (5.6%) were identified as having abnormal/pre-cancerous lesions on initial visual inspection with acetic acid (VIA) examination. Of the 24 women with lesions on their cervix, all 15 (100%) women with lesions covering less than 75% of their cervix received cryotherapy or thermoablation, procedures performed at the health facility, immediately after the lesions were identified. Six (67%) out of the nine remaining women with lesions covering 75% or more of their cervix were referred to the Quelimane Central Hospital to receive higher-level care, where they underwent LEEP (Loop Electrosurgical Excision Procedure), an effective and safe procedure that prevents cervical cancer by removing abnormal cells from a woman’s cervix using a small electrical wire loop.

These results were achieved through the Avante Program. Avante is funded by PEPFAR through the Centers for Disease Control and Prevention (CDC) and seeks to control the HIV epidemic by supporting the sustainable implementation of HIV services in Zambézia Province. Avante is implemented by the Vanderbilt University Medical Center (VUMC) and its affiliate Friends in Global Health (FGH), which works in partnership with the Government of Mozambique at the national, provincial, district, health facility, and community levels.

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Tens of thousands remain on combination antiretroviral therapy in Zambézia Province despite widespread flooding

esmaer2 — Wed, 11 May 2022 09:36:57 +0000

Tens of thousands remain on combination antiretroviral therapy in Zambézia Province despite widespread flooding esmaer2 Wed, 05/11/2022 - 04:36 RSS:

FGH Communications Team (in-country)

FGH peer educators transporting medications and supplies to areas inaccessible by car due to the rains

“The medicine I am using is important to me because it helps me to be healthier.”
Manuela dos Santos António, Namacurra District

This simple statement by Manuela dos Santos António perfectly encapsulates the reason why Friends in Global Health (FGH) was compelled to mobilize technical staff, vehicles, boats, and volunteers - to ensure that health facilities (HFs) could continue to offer combination antiretroviral therapy (ART) to persons with HIV (PWH), even in the face of two fierce tropical storms, Ana and Gombe, that flooded large parts of Zambézia Province and threatened access to healthcare for thousands of people.

Tropical Storm Ana hit northern Mozambique on January 24, 2022. Ana caused hundreds of injuries, several deaths, and left a trail of destruction that cut electricity, and destroyed hospitals, schools, houses, crops, roads, and bridges. Further aggravating the situation, less than two months later, on March 15, 2022, the same region was hit by the intense Tropical Cyclone Gombe.

The FGH supported district of Namacurra, lies in a basin that is prone to flooding and this year’s floods were much more severe compared to prior seasons. “We could not access Macuse Administrative Post, (…) we had many difficulties sending medical supplies and medicines needed at health facilities (…)” explains Dr. Saquina Messia – Namacurra Chief Medical Officer.

Dr. Geraldo Duarte, Director of Namacurra District Health Authorities during a flood-response planning session with FGH District Coordinator Augusto Chambule

Namacurra is at the epicenter of the Mozambican HIV epidemic with more than 34,000 persons with HIV (PWH) currently receiving potentially life-saving ART at 10 HFs supported by FGH. Five of these HFs, each currently providing ART to over 14,500 individuals, were isolated by the flooding. “It was a dramatic event” explains Dr. Geraldo Duarte, Namacurra Health Director. The widespread flooding could have resulted in “an aggravation of epidemics, because we could have had people without access to ARVs, (…) this could have had serious clinical consequences.”

Supplies, including fuel for power generators used at HFs, loaded onto FGH’s boat on its way to Macuse HF.

To avoid this, FGH staff continued to support HIV and TB services in isolated HFs. As soon as the storm passed, FGH transported 1.5 tons of essential medicines to the Macuse Health Facility. This was not an easy task. Medicines were transported by car for 88 kilometers, followed by boat for another 15 kilometers, and then a motorcycle, bicycle, and even on foot. “When all access roads were blocked, we received the medicines by water, which is not an easy process," added Nelson Jafar, head of Macuse Sede HF.

Graça Raul, an FGH-supported counselor, during an ART counseling session with Manuela dos Santos António at Macuse HF.

Manuela dos Santos António, a 23 year old farmer and mother of two children, lives in the flooded area of Macuse. “I had difficulties getting to the health facility because the roads were full of water; but even then, I managed to get to the health facility to collect my [ARV] medication” says. With FGH support, Manuela has been on ART since 2017. She is fully aware of the importance of not interrupting ART.

The Avante Program is funded by PEPFAR through the Centers for Prevention and Disease Control (CDC). By the end of March 2022, the Avante Program was supporting over 320,000 PWH currently receiving ART.

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Community-based ART distribution - A lifesaver for tens of thousands of people living with HIV during the COVID-19 pandemic

ridingkm — Mon, 03 Jan 2022 21:17:54 +0000

Community-based ART distribution - A lifesaver for tens of thousands of people living with HIV during the COVID-19 pandemic ridingkm Mon, 01/03/2022 - 15:17 RSS:

FGH Communications Team (in-country)

Osvaldo Ramos Dias Movere crosses the river to visit a patient to perform a Community-based ART distribution.

“Now I understand what COVID-19 is, how to protect myself, and what I need to do to continue my consultations and HIV medication.” Ticha Emiliano at Namuinho Health Facility, Quelimane District.

As on any other typical Saturday, Osvaldo Ramos Dias Movere begins his work crossing the Macuse River in a traditional canoe. When he arrives at Idugo Island, he catches a lift on the back of a Peer Educator’s bicycle. Together they make home visits to patients who have interrupted antiretroviral therapy (ART). Osvaldo is just one of 235 FGH-supported Clinical Officers who collectively visit thousands of patients daily, ensuring that COVID-19 does not hinder efforts to control the HIV epidemic in Zambézia Province.

“Weekends, particularly Saturdays, are the best days to find patients because that’s when they are normally at home after returning from tending their fields,” says Osvaldo.

A combination of factors has long been responsible for HIV treatment interruption, including lack of money for transportation, temporarily moving to lower terrain for better farming, travel during the holiday season, and stigma, among others. The COVID-19 pandemic has been an important new factor that has kept thousands of patients away from health facilities since March 2020.

This is how Mussa Mbeve, a patient receiving ART at Macuse Health Facility in Namacurra District, vividly recalls interrupting ART due to COVID-19: "Corona [COVID-19] was the reason I stopped going to the hospital. The government said people must not gather in large crowds in places such as mosques, [football] games... All ceremonies were stopped because of Corona [COVID-19]."

In a similar tone, a dozen miles away, Ticha Emiliano, a patient at Namuinho Health Facility in Maquival, Quelimane District, also told us she stopped going to the health facility for HIV Care & Treatment services due to fears of contracting COVID-19.

Ticha and her children help their father prepare his bicycle to go to the market to sell artisanal agricultural products.

In her own words, “I was afraid of that disease… Corona [COVID-19]. I was afraid because of the news I had received, that people can no longer crowd together, thus, I was afraid to go into the health center because a lot of people go there. That’s what made me interrupt treatment.”

Thanks to the clarifications and assurances provided by clinicians such as Osvaldo, Ticha and Mussa, many other patients are now re-engaged in care and back on treatment. Osvaldo sits with patients who have interrupted treatment in their homes, providing psychosocial support sessions and delivering life-saving ART and TB preventive therapy (TPT). He enjoys the challenging nature of this work: “We are well prepared. We have bicycles, raincoats, boots, a backpack to carry the medications, and a logbook to register the ART delivery. We visit patients even when it rains. The boat pilot keeps rowing while someone else bails water out of the canoe with a plastic bottle during the journey across the river.”

Lussete Bissane (Director of Namuinho HF) analyzing Community-based ART distribution data.

Lussete Bissane, Director of Namuinho Health Facility, confirms that COVID-19 has negatively impacted the HIV program at her facility. “It was a result of information broadcasted on the radio that told people to stay at home. We started noticing that normal patient flow was decreasing, and we started noticing interruptions of ART not only for adults but for children as well. As the patient flow decreased, we realized something was wrong. Even pregnant women enrolled in the HIV program weren’t attending antenatal consultations.”

In response to this situation and in coordination with the provincial health authorities, FGH initiated Community-based ART distribution as a strategy to reach those patients who interrupted treatment during the COVID-19 pandemic. Clinical Officers were hired to visit patient homes, provide ART and Tuberculosis preventive therapy (TPT), reinforce ART adherence messages, and clearly instruct patients to visit their local health facility for their next consultation and medication pick-up. FGH trained and equipped Clinical Officers with bicycles, monitoring forms, and basic supplies like boots, raincoats, and backpacks. Communication activities, such as community radio messages and community theater performances, were also implemented to strengthen the acceptance of Community-based ART distribution.

Osvaldo Ramos Dias Movere getting a lift from a Peer Educator to visit a patient to perform Community-based ART distribution, after having crossed the river on a traditional canoe.

Macuse Health Facility Interim Lead Jacinto Manuel Bata adds, “Community-based ART distribution is a very good initiative because it came to provide reinforcements, it recovered individuals who had interrupted treatment, or who had weak retention to HIV services.”

By the end of December 2021, 56,350 people were back on ART as a result of Community-based ART distribution, representing 18% of the total number of patients on ART (317,142) at FGH-supported health facilities.

These results were achieved through the Avante Program. Avante is funded by PEPFAR through the Centers for Prevention and Disease Control (CDC) and seeks to control the HIV epidemic by supporting the sustainable implementation of HIV and Tuberculosis (TB) services in the province of Zambézia. Avante is implemented by Vanderbilt University Medical Center (VUMC) and its affiliated Friends in Global Health (FGH) which work in partnership with the Government of Mozambique at the national, provincial, district, health facility, and community levels.

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HIV treatment continues for thousands during the COVID-19 pandemic

ridingkm — Mon, 30 Aug 2021 14:30:46 +0000

HIV treatment continues for thousands during the COVID-19 pandemic ridingkm Mon, 08/30/2021 - 09:30 RSS:

FGH Communications Team (in-country)

Melo Melo, Namacurra’s main health facility (HF) interim clinical Director analyzing a patient’s card during a consultation

“This intervention allows us to recover every single patient that had interrupted treatment.” Melo Melo, Interim Clinical Director of Namacurra Health Facility.

In January 2021, there was a significant decrease in the number of patients visiting health facilities (HFs) in Mozambique. A combination of the holiday season and a surge in the number of COVID-19 cases kept people away. At the time, as many as 16,660 patients interrupted their HIV care across the 144 FGH-supported HFs in Zambézia Province. Patient Carimo Mamudo Aliz told us, “We are afraid of Corona [COVID-19]…[before] the health facility was packed with people. We are afraid of Corona, but we want to take our medication.”

The overall number of patients currently receiving ART at the end of January 2021 dropped by 3.4%, the largest decrease seen over a month-long period in the last three years at FGH-supported HFs. To address the issue, in February 2021, FGH mobilized 160 Clinical Officers to implement community ART distribution focusing on those patients who had interrupted treatment. Clinical Officers visit patients’ homes to provide ART and Tuberculosis Preventive Treatment (TPT). They reinforce ART adherence messages and clearly explain that patients must visit the HF in person for their next consultation and medication pickup. FGH equipped these Clinical Officers with bicycles, monitoring forms, and basic supplies (e.g., boots, raincoats, and backpacks).

The initiative has been implemented at 47 FGH supported HFs. Nelson Jafar, director of Macuse HF, said that this initiative has brought many gains to his HF’s patient community. “Those patients that had abandoned [HIV] treatment are coming back and are becoming adherent to treatment. The number of patients on [HIV] treatment is increasing.”

Namacurra HF currently serves over 10,000 ART-treated patients, making it one of the largest ART-service delivery sites in Mozambique. Interim Clinical Director, Melo Melo, enthusiastically told us, “This intervention allows us to recover every single patient that had interrupted treatment.”

Clinical officer providing ART medication to Carimo Mamudo Aliz during a community distribution of ART

By the end of June 2021, FGH was supporting the provision of ART to more than 281,000 people living with HIV and this was only possible thanks to the Community ART distribution activity that FGH initiated in February 2021 and intensified during the April through June 2021 period (COP20 Quarter 3).

To understand the impact of community ART distribution on reducing the number of patients interrupting HIV treatment and on the evolution of the overall number of patients receiving ART, a comparison was made between the 47 FGH supported HFs fully implementing community-based distribution of ART and the remaining 97 HFs which were not yet consistently implementing the intervention. From April to June 2021, over 46,790 community-based ART distribution visits were performed by the HFs implementing the intervention consistently, representing 95% of all community ART distributions performed in the reporting period. As a result, when compared to the previous reporting period, the number of patients who interrupted treatment reduced by 53.2% in the HFs that began implementing community ART distribution in Quarter 3 when compared to Quarter 2, and a greater than 4-fold (417%) increase in the number of patients who were more than 28 days past their last expected clinical contact who return to treatment and restarted ART in the reporting period (TX_RTT), when compared to Quarter 2 performance. In the 15 HFs where the community-based ART distribution was initiated back in Q2 COP20 (February 2021), a total of 27,746 (56% of all community ART distributions) were performed in these HFs, and these community ART distributions originated from these supported HFs resulted in a 147% increase in the number of patients who were more than 28 days past their last expected clinical contact who return to treatment and restarted ART in the reporting period (TX_RTT), when compared to Quarter 2 performance.

Macuse’s HF director analyzing registration of patients that return to the HF after community distribution of ART

Considering the positive impact on programmatic indicators, FGH, worked in coordination with provincial health authorities to increase the number of clinical officers implementing community ART distribution to a total of 236.

These results were achieved through the Avante program. Avante is funded by PEPFAR through the Centers for Prevention and Disease Control (CDC) and seeks to control the HIV epidemic by supporting the sustainable implementation of HIV and Tuberculosis (TB) services in Zambézia Province. Avante is implemented by Friends in Global Health (FGH), an NGO affiliated with Vanderbilt University Medical Center. Since 2006, FGH has worked in partnership with the Government of Mozambique at the national, provincial, district, health facility, and community levels in Zambézia Province.

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Increased access to Cervical Cancer Screening Improves Women’s lives in Zambézia

ridingkm — Mon, 31 May 2021 14:25:58 +0000

Increased access to Cervical Cancer Screening Improves Women’s lives in Zambézia ridingkm Mon, 05/31/2021 - 09:25 RSS:

FGH Communications Team (in-country)

Teresa Manuel S. Pinto preparing food with her daughter

“I had been feeling bad. In December 2020, FGH took me to Mocuba (District Hospital) where I had the cervical cancer screening done. The result came back positive.”

After receiving a positive cervical cancer screening test result, Teresa Manuel S. Pinto commenced cervical cancer treatment. Teresa’s situation is representative of the reality for many Mozambican women. Invasive cervical cancer is the most prevalent cancer in Mozambican women (31% of all female cancers). And, according to UNAIDS [1], cervical cancer is the most prevalent cancer among women living with HIV. A woman living with HIV is up to five times more likely to develop invasive cervical cancer compared to a woman without HIV. If not treated, cervical cancer can lead to significant morbidity and mortality. Yet, if detected early, cervical cancer is treatable and has high treatment success rates. Bernardete Bernardo Segundo, Director of the 24 de Julho Health Facility, emphasizes “When diagnosis is made early, it is less likely serious illness will develop, and the easier the treatment will be.”

4 de Dezembro Health Facility director Bernardete Bernardo Segundo consulting Cervical Cancer images

Cervical cancer screening and treatment are not always available in Mozambique’s Health Facilities. Ideally, cervical cancer would be screened through a Pap smear, which represents the gold standard for cervical cancer screening. Yet, Pap smears require proper laboratories and skilled practitioners to not only perform the test but also to read/interpret the results. For this reason FGH, following Ministry of Health guidance, has been working with the Provincial Health Directorate to introduce and expand Visual Inspection with Acetic Acid (VIA) services as a sustainable alternative to the Pap smear. VIA is used as a low-cost visual inspection cervical screening, which is performed by rubbing acetic acid on the cervix and can be done by a trained healthcare professional. VIA is considered to be as effective as a Pap smear, with the advantages of having the result and treatment performed during the same visit, as women do not need to wait for the results and return later for a consultation, thus diminishing financial burden to patients and improving treatment outcomes.

Having been initiated on cervical cancer treatment, Teresa recalls that “Before receiving cervical cancer treatment, my life was not going well. I was really bad off. I was bleeding, I couldn't sleep, my spine and my bladder hurt, I couldn't cultivate my field, I couldn't wash my clothes.”

As a result of the treatment, she says that “Now I am comfortable, I have no problems. The problem of cervical cancer is gone. (…) If it weren't for FGH I would have lost my life.”

4 de Dezembro Health Facility director Bernardete Bernardo Segundo providing instructions on Cervical Cancer related medical instruments to a maternal and child health nurse

From October 2020 to March 2021, more than 26,000 HIV-positive women underwent cervical cancer screening with FGH assistance, representing a 37% increase when compared to the previous reporting period (April to September 2020). 1,075 (80%) eligible women eligible received cryotherapy treatment . These results represent an important improvement from the last reporting period (April to September 2020) when only 48% of the women with a positive screening received cryotherapy.

Through the Avante Program, FGH is working to address barriers that inhibit women from receiving cryotherapy treatment: they enable transportation for women who are diagnosed at peripheral Health Facilities where cryotherapy equipment is not available, they are expanding the availability of cryotherapy equipment and ensuring that cryotherapy equipment is functional. FGH also supports health communication activities that aim to change social/cultural norms including the need for women to obtain their husband’s permission to undergo the procedure.

The Avante Program is funded by PEPFAR through the Centers for Prevention and Disease Control (CDC) and seeks to control the HIV epidemic by supporting the sustainable implementation of HIV and TB services in the province of Zambézia. The Avante Program is implemented by FGH, an NGO affiliated with Vanderbilt University Medical Center that works in partnership with the Government of Mozambique at the national, provincial, district, Health Facility, and community levels. FGH has been working in Zambézia Province since 2006.

[1] https://www.unaids.org/en/resources/presscentre/featurestories/2019/may…

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Towards the Elimination of Mother-to-Child HIV Transmission

ridingkm — Sun, 28 Feb 2021 15:17:38 +0000

Towards the Elimination of Mother-to-Child HIV Transmission ridingkm Sun, 02/28/2021 - 09:17 RSS:

FGH Communications Team (in-country)

“Community follow-up is essential. It is indispensable. FGH support of community personnel who make this immediate and permanent connection with patients is something I consider fundamental for the achievement of these results.” – Dr. Tilvério Gasolina

Mozambique ranks among the countries with the highest number of incident HIV infections in children, the vast majority of which are the result of vertical transmission, also commonly referred to as mother-to-child transmission. An effort focused on the elimination vertical transmission of HIV in Mozambique began in 2011, when the Mozambican Ministry of Health set out its initial goal of having a national vertical transmission rate less than 5%.

A patient having a conversation with a Mentor Mother

In COP20 Quarter 1 in Zambézia Province, the vertical transmission rate across 144 FGH supported Health Facilities was 4.9%. Out of all supported HFs, 40 had 0% transmission of HIV from HIV-positive mothers to their newborns between October 1, 2020 and December 31, 2020. To achieve this result, the FGH multidisciplinary teams in the supported districts implemented a variety of interventions including but not limited to technical assistance, joint supervision visits, and clinical mentoring to improve the care and treatment of pregnant and lactating women with HIV. Technical assistance was also provided to Mentor Mother volunteers to improve knowledge and skills about HIV and PMTCT care to better manage the challenges faced during their activities at the community level. In addition, at supported HFs with the highest number of vertical transmission rates, there were in-depth discussions (a minimum of monthly) of of all incident HIV-positive infants to identify why such cases occurred , as well as the development of specific action plans to address the root causes.

The 17 de Setembro HF in Quelimane was one site that achieved a 0% vertical transmission rate. During COP20 Quarter 1, there were 109 infants (0-12 months of age) born to HIV-positive mothers. Not one of these HIV-exposed infants (HEI) has has tested HIV-positive.

Dr. Tilvério Gasolina, Clinical Director of the 17 de Setembro HF, praised FGH support, specifically the technical and mentoring support provided to HFs.

“There are technicians who are allocated to health facilities who regularly provide support to various sectors. Another aspect of support has to do with logistical issues - FGH provides logistical support to different areas to improve the provision and quality of services.”

In addition, Dr. Atanásio Fiscal, the Director of the Namacurra Sede HF, emphasizing the clinical-community linkages component offered the following statement,

“With the support that we have received from our community actors - I’m especially referring to Mentor Mothers - we have been accompanying pregnant women from prenatal consultations to the moment of delivery. This is what has greatly leveraged women to accept services, to accept HIV care and treatment, and to adhere to treatment."

Namacurra HF Director going through patient files

During Quarter 1, the Namacurra Sede HF achieved a 5% vertical transmission rate. Out of the 202 HIV-exposed infants (0-12 months of age) born to HIV- positive mothers and tested for HIV, 10 children were identified as being HIV-positive. The goal is definitely 0, but this is a step in the right direction at such a large supported HF.

In total, in COP20 Quarter 1, across 144 FGH supported HFs in Zambézia, 5,380 HIV-exposed infants (0-12 months of age) born to HIV-positive mothers were tested for HIV. Of these, 266 (4.9%) children were identified as HIV-positive.

The 0% vertical transmission rate achieved by the 17 de Setembro HF and 39 other HFs can serve as great inspiration. If they are able to continue on this path, achieving the elimination of vertical transmission is possible.

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Clinical Advisor’s Commitment Leads to a More Than Threefold Increase in Patients Completing Tuberculosis Preventive Therapy (TPT)

ridingkm — Fri, 20 Nov 2020 22:13:31 +0000

Clinical Advisor’s Commitment Leads to a More Than Threefold Increase in Patients Completing Tuberculosis Preventive Therapy (TPT) ridingkm Fri, 11/20/2020 - 16:13 RSS:

FGH Communications Team (in-country)

“It’s valuable work; if Clinical Advisors ceased to exist, data would fall.”
Timóteo Makenda
Quelimane District HIV and STI Focal Point

In the first quarter of COP19, VUMC/FGH faced a 33% budget reduction, compared to the COP18 budget. As a result, the VUMC/FGH team was restructured, including a reduction in the provincial and district TB teams. As a consequence, during COP19, the VUMC/FGH TB program had only one TB/HIV Provincial Manager and two Regional TB/HIV Coordinators.

Salvador dos Santos (Quelimane National TB Control Program supervisor) attending a patient Photographer: Abú Choe

Simultaneously, new data and care & treatment tools (e.g. master card) were being introduced, leading to overburdened data clerks taking on additional tasks, leading to issues with data quality and completeness. This may have affected Tuberculosis (TB) Preventive Therapy (TPT) initiation and data completion capturing. With the transition to these new tools, the majority of the electronic patient database (OpenMRS) reports needed to be revised to include the new patient file variables. This process hindered the optimal implementation of FGH’s Standard Operating Procedure (SOP) that tracks the proportion of HIV-positive, ART-treated patients who initiated a standard course of TPT in the prior reporting period that also completed therapy (TB_PREV data triangulation SOP). Such constraints negatively impacted TPT initiation, patients being registered as initiating TPT, and patient data completion.

As a result, during Q4 of COP19, the FGH District Clinical Advisors commenced a more intensive monitoring of the implementation of the TB_PREV data triangulation SOP while balancing their time between HIV and TB activities, with support from FGH’s Monitoring &Evaluation team. The successful implementation of this SOP was only possible thanks to the engagement and invaluable contributions of the Clinical Advisors.

"It was hard work because we worked at a time without ODACs [District Collaborative Activities Officers (TB staff)], so the Clinical Advisor also ended up taking over the ODAC position, which directly monitored this indicator. So, when we lost ODACs, Clinical Advisors started working directly with this indicator [TB_PREV]. Despite the many activities that Clinical Advisors had, in order to have good results they also had to find a way to monitor this indicator. There were several interventions ... we had support from the provincial team and the national team in devising new approaches, methodologies and new strategies to improve." said Tânia Mulhanga, an FGH Clinical Advisors involved in this process.

Tânia Mulhanga (FGH Clinical Advisor) explaining TB medication regime to a patient Photographer: Antonio Ambelikola

During semester 1 (S1) COP19 (October 2019 – March 2020), 6,141 of patients who initiated TPT during Semester 2 (S2) COP18 completed a six-month course of TPT. However, during the recently completed Semester (Semester 2 (S2)) of COP19 (April 2020 – September 2020), 18,362 patients who initiated TPT during S1 COP19 completed a six-month course of TPT with Isoniazid, representing an ~ 3-fold increase when compared to S1 COP19 performance. According to UNAIDS, TB is one of the leading causes of death amongst people living with HIV, which makes the achieved results significant. Ensuring full coverage of TPT for all eligible PLHIV is an indispensable part of reducing HIV-associated mortality.

“The team of District Clinical Advisors who worked with me worked very well. They implemented certain strategies that helped us [in the National Health System] so much in the improvement of some of our data. (…) If it were not for the District Clinical Advisors, I think that we, in the National Health System, would not have overcome one or another barrier (…) It’s valuable work. If Clinical Advisors ceased to exist, data would fall.” Timóteo Makenda, Quelimane District HIV and STI Focal Point.

Timoteo Makenda (Quelimane HIV and STI focal point) analyzing TB data Photographer: Abú Choe

Tags

Quelimane, HIV/Tuberculosis

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FGH Rapidly Expands 3-month ART Dispensation during the COVID-19 Pandemic

ridingkm — Tue, 15 Sep 2020 21:40:13 +0000

FGH Rapidly Expands 3-month ART Dispensation during the COVID-19 Pandemic ridingkm Tue, 09/15/2020 - 16:40 RSS:

FGH Communications Team (in-country)

By the end of June 2020, 185,849 patients on combination antiretroviral therapy (ART) were receiving their medication refills on a quarterly basis, commonly referred to as three-month drug dispensation (3MDD). This number represents an impressive 76% of all patients currently receiving ART. This is more than a three-fold increase from the previous reporting period (54,282 patients at the end of COP19 Q2) - the largest proportional increase FGH supported health facilities have ever registered during any reporting period.

A patient collects three-month’s worth of ARV medication at Maquival Sede Health Facility Photographer: Alferes Ledesse

Such an achievement is the result of a specific set of measures implemented in response to the COVID-19 pandemic, including the relaxation of the eligibility criteria for three-month ART dispensation by the Mozambican Ministry of Health (MOH). Three-month ART dispensation can help mitigate the spread of COVID-19 by markedly reducing the total number of patients visiting health facilities and avoiding large numbers of patients queued up in congested waiting areas.

The modifications to three-month ART dispensation eligibility criteria enabled a larger percentage of patients currently receiving ART to participate in this intervention. All ART-treated patients qualified for three-month ART dispensation, with the following exclusions: children less than two years of age, children and adults during their first three months on ART, lactating women during the three-month period after birth, TB/HIV co-infected patients, and patients in need of more regular clinical follow-up due to other underlying health conditions.

FGH led the operationalization of these guidelines and the implementation of changes in patient flow, for example, the utilization of one-stop models to facilitate access to ART while avoiding long queues at public pharmacies. These interventions accommodate changes in guidelines within supported health facilities. FGH provides active mentoring to providers to improve implementation of the guidelines. Daily tracking of the inclusion of patients on three-month ART dispensation was also implemented in all 144 FGH supported health facilities with the timely identification of solutions at underperforming sites.

FGH developed an informational radio spot promoting three-month ART dispensation and encouraging patients to adhere to ART as a way to prevent potential serious morbidity and mortality caused by COVID-19 infection. The radio spot was approved by MOH and the provincial health authorities and was aired by all community radio stations in prioritized districts.

A health counselor phones a patient to come collect his ARV medication, at 24 de Julho Health Facility in Quelimane Photographer: Josefina Supinho

In mid-March 2020, following worldwide recommendations of social distancing and travel restrictions as a result of the COVID-19 pandemic, FGH instated an institutional travel ban, suspending all travel between its headquarters in Maputo and Quelimane, where programmatic operations take place. Travel was also markedly reduced between FGH headquarters in Quelimane and rural supported districts and health facilities. These restrictions complicated the ability of the central and provincial technical teams to provide their quality supervision and mentoring to the district teams. FGH technical teams overcame these challenges with improvisation and resiliency, maintaining consistent communication with district and health facility-based personnel through regular Zoom calls. Teams shared and discussed data regarding numbers of patients being transitioned to three-month dispensation and interventions were implemented in real time, as needed, to ensure the rapid scale-up of this important differentiated model of service delivery.

A patient collects three-month’s worth of ARV medication at Maquival Sede Health Facility Photographer: Alferes Ledesse

In early April 2020, MOH provided additional guidance related to the continuity of HIV services within the context of the COVID-19 pandemic, which included the temporary suspension of all community health testing and counseling, all preventive and defaulter contact tracing home visits for HIV-positive pregnant and lactating women, children and adults in HIV care and treatment, and all differentiated service delivery models that involved patient group meetings and gatherings including adherence clubs and mobile brigades for ART distribution. While the suspension of these activities posed a great challenge to the program, rapidly modifying the eligibility criteria and expanding the implementation of three month ART drug dispensation was able to mitigate potentially poor outcomes.

A patient receiving counseling about receiving three-month’s worth of ARV medication, at 24 de Julho health facility in Quelimane Photographer: Josefina Supinho

By successfully and rapidly implementing three month ART drug dispensation for eligible patients within the 144 FGH supported health facilities, at the end of the reporting period (Q3), a total of 245,515 patients were currently receiving ART, which corresponds to 75% of annual target achievement in terms of performance for this indicator. This achievement included an impressive net increase of 16,006 patients (11,252 patients newly initiating ART during this reporting period coupled with 4,754 patients re-engaging in care), corresponding to a 7% increase when compared to the total number of persons currently receiving ART at the end of the previous reporting period (Q2).

Lastly, the proportion of eligible ART-treated persons receiving their ART via three-monthly dispensation recently surpassed 80%, so there is still some room for expansion, and FGH will continue to track progress and rapidly implement interventions in order to take this to full scale, ensuring continuity of services and patient safety in the midst of the COVID-19 pandemic.

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COVID-10, Quelimane, Pharmacy Services

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Innovative intervention within Triage Ward and Emergency Rooms Leads to Impressive Preliminary HIV Testing Services Results

ridingkm — Wed, 03 Jun 2020 22:35:09 +0000

Innovative intervention within Triage Ward and Emergency Rooms Leads to Impressive Preliminary HIV Testing Services Results ridingkm Wed, 06/03/2020 - 17:35 RSS:

FGH Communications Team (in-country)

Testing activity within triage ward and emergency room (ER) testing points within large Health Facilities (HF) is relatively low due to clinicians’ high workload. Consequently, there is low routine screening and referral of patients to HIV testing and counseling (HTC) services from these service delivery points. As a solution to this problem, FGH, in coordination with Mozambique’s Health authorities, implemented HIV HTC within emergency rooms facilitated by health counselors, which resulted in a considerable increase in the overall numbers of persons being tested and in the numbers of persons being newly identified as being HIV-positive

Vilma Santos, Maquival Sede HTC counselor, counselling a patient. Photo credit: Rui Esmael

With the implementation of this new novel HTC strategy, Vilma Santos, an HTC health counselor who works in Quelimane City at the Maquival Sede Health Center has started to screen patients herself at the ER. Together with another counselor she supports the clinician in screening, easing the clinician’s daily workload, resulting in the HF’s increased capacity to identify new HIV- positive patients. Vilma and her coworkers have been able to witness the impact of this strategy firsthand, “We found a huge difference because the sector where I used to work did not have much productivity, but when I started working in the ER, I started to feel a lot of productivity, the testing and the data increased a lot. (...) I can track many patients because all the patients go through me before going to the doctor's appointment, and if necessary, I offer the HIV test.”

“We found a huge difference because the sector where I used to work did not have much productivity, but when I started working in the ER, I started to feel a lot of productivity, the testing and the data increased a lot. (...) I can track many patients because all the patients go through me before going to the doctor's appointment, and if necessary, I offer the HIV test.”

Vilma Santos reviews her patient’s records at Maquival Sede Health Center. Photo credit: Rui Esmael

For each client in the waiting room, counselors screen for risk of exposure and/or signs and symptoms correlated with acute or chronic HIV infection. If there has been exposure or if any signs or symptoms are identified, and this patient has not been tested for HIV in the last 3 months and is not already on ART, then the counselors offer HTC. Counselors also check to see if clients in the consultation waiting room belong to any key population (e.g. Female Sex Workers, Men Who Have Sex with Men, People who Inject Drugs, and Prisoners) who should be tested for HIV every 3 months, if HIV negative.

In addition, the DisaLink laboratory results system has been installed in all FGH-supported districts except Mulevala to ensure that district-level VL requests are immediately available at QGH. Once results are processed at QGH, they are made available in real-time to the District Sedes, saving time and other additional resources. To this end, FGH has contracted twenty-four digitizers based in the District Sede HFs and other high-volume HFs. The staff support DisaLink systems operations and enter results into OpenMRS, making the results available to the provider to properly inform and guide clinical care decisions for their patients. Today, over 16,000 VL results are provided monthly, compared to approximately 7,000 per month a year ago.

Dr. Maria Madeira, a physician and Maquival Sede Health Center’s Clinical Director says “The initiative is good since the data has improved a lot. It has helped cover most patients who enter the HF. We are testing more and testing more gives more people the possibility of knowing their sero-status. We advise those who are negative to adhere to preventive measures, and to those with a positive [HIV] test result we advise them to initiate [HIV] treatment." Dr. Madeira adds “The intervention is an asset because we have asymptomatic patients, most of whom are in good general condition starting [HIV] treatment.” She concludes by emphasizing “The lives of those who are adherent improve a lot, and they are very grateful.”

HTC services in an ER setting contributed 41% of the total number of new HIV-positive individuals identified at FGH-supported HFs during Q2. A total of 88,182 individuals were tested during Q2 in an ER setting, representing 130% achievement of the quarterly target and a 9% increase when compared to Q1 performance (88,182 in Q2 vs. 80,996 in Q1). The number of newly identified HIV-positive individuals (5,602) represented 119% achievement of the quarterly target, presenting a 6% increase when compared to Q1 performance (5,279 in Q1 vs. 5,602 in Q2). The HIV test positivity rate in Q2 was similar to that seen in Q1, namely, 6.4% in Q2 vs. 6.5% in Q1.

Maria Madeira, Maquival Sede Health Center Clinical Director, assessing a patient. Photo credit: Margareth Gonsalves

Implementation of the counselor-based HIV-risk screening tool as per Ministry of Health (MoH) Differentiated Service Delivery (DSD) guidelines for HTC commenced in August 2019 at 16 large Phase 1 supported HFs. In Q2, the FGH HTC team initiated the expansion of the counselor-based HIV-risk screening tool. At Phase 1 HFs, the number of new HIV-positive individuals being identified within an ER setting remained constant (2,527 in Q2 vs. 2,517 in Q1), but the overall test positivity rate decreased from 7.0% in Q1 to 6.4% in Q2. The majority of supported Phase 1 HFs had already initiated the new activity in Q1, but a number of them presented significant decreases in terms of the number of new HIV-positive individuals being identified, including Licari (-34%), Chabeco (-29%), 24 de Julho (-24%), and Coalane (-22%). Phase 1 HFs that initiated the activity in Q2 presented significant increases, examples of which include the Sede HFs of Alto Molócuè (29%) and Inhassunge (25%). In Phase 2 supported HFs, the number of new HIV-positive individuals being identified at an Emergency room setting presented a significant (10%) increase (2,492 in Q2 vs. 2,259 in Q1), with test positivity presenting a slight increase (6.8% in Q2 compared to 6.6% in Q1. In Phase 3 supported HFs, the number of new HIV-positive individuals identified within an ER setting presented a significant (16%) increase (583 in Q2 when compared to 503 in Q1), with test positivity presenting a slight increase (4.8% in Q2 compared to 4.7% in Q1). The FGH HTC team will reinforce mentoring and close supervision of counselors within an ER setting to ensure that implementation of the counselor-initiated testing and counseling has a long-lasting positive effect.

In summary, this novel counselor-initiated, HIV risk-based (signs and symptoms) screening approach has resulted in impressive preliminary results. FGH plans to take this initiative to scale in other supported HFs during subsequent reporting periods in order to improve HIV testing and counseling performance.

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Implementation of a Standardized Operating Procedure Successfully Improved the Receipt of Viral Load Results Among ART-Treated Eligible Adults and Children Receiving Longitudinal HIV Care at the Namacurra Sede in Zambézia Province, Mozambique

ridingkm — Fri, 14 Feb 2020 19:24:01 +0000

Implementation of a Standardized Operating Procedure Successfully Improved the Receipt of Viral Load Results Among ART-Treated Eligible Adults and Children Receiving Longitudinal HIV Care at the Namacurra Sede in Zambézia Province, Mozambique ridingkm Fri, 02/14/2020 - 13:24 RSS:

FGH Communications Team (in-country)

In Mozambique, in 2015, viral load (VL) testing became routine for pregnant and lactating women (PLW) who had been receiving combination antiretroviral therapy (ART) for 3 months or longer. It is very important to monitor VL in patients receiving ART in order to determine whether or not the patient is adhering to their prescribed ART regime and whether or not their treatment is effectively suppressing HIV in the body. Recent programmatic data showed an overall VL coverage rate of approximately 40% in COP18. By the end of COP19 Q1, VL coverage at FGH supported sites had risen to 49%.

António Fiscal (Namacurra HF Director) reviewing a patient’s Viral Load results Photo credit: Rui Esmael

To improve the requisition and clinical file availability of VL test results for patients who are eligible for routine VL monitoring, a specific intervention was designed by FGH in collaboration with the Provincial Health Directorate (DPS). The intervention was based on the introduction of a specific tool for tracking VL results from the time of the initial VL test requisition up until the results were made available in the patient’s clinical file and shared with the patient or the patient’s caregiver. The tool included the weekly monitoring of process measures such as the number of VL samples collected, the number of VL results updated in the electronic patient tracking system (EPTS), and the number of printed VL results inserted into the patient clinical files. The standard operating procedure (SOP) explaining how to properly utilize the tool and perform the necessary monitoring were shared with the district-based clinical implementation teams. In May 2019, implementation of the VL results SOP was initiated in 20 high-volume HFs in Zambézia Province. The provincial and national clinical management teams provided regular feedback on performance of weekly targets in real-time.

Namacurra Sede HF was one of the 20 HFs implementing this intervention. Results were evaluated through a cascade analysis including all steps leading up to VL results being communicated to eligible HIV-positive, ART-treated pediatric and adult patients (including pregnant and lactating women), before and after implementation of the SOP. Significant improvements were observed in each of these target groups, with the most significant improvement being noted in pregnant and lactating women, as shown in Figure 1 below:

Figure 1: Namacurra Sede Health Facility Pregnant and Lactating Women Viral Load Cascade before and after implementation of the SOP

The results of the implementation of the VL results SOP led to substantial increases in i) the proportion of VL requests registered, from 52% to 89% among eligible patients, ii) the placement of VL results into available patient clinical files within the HF, from 62% to 90%, and iii) the communication of VL results to the patient or patient’s caregiver, from 20% to 60%.

Jair Fataha (FGH Clinical Advisor) and Sisinio Jorge (Patient Receptionist) assessing the completeness of Viral Load Results in the tracking sheet credit: Rui Esmael

As explained by Jair Fatha, the Friends in Global Health (FGH) Clinical Advisor for Namacurra District, the efficient use of the VL tracking tool helped to overcome the serious bottleneck around the insertion of printed VL results into the patient clinical files: “The laboratory would send viral loads to reception area within the HF, but receptionists did not always insert them all into patient clinical files. When we went to reception, we found a lot of results were not included in the clinical files. As a result, the patients came to the appointment and left without knowing their results, and the clinical staff did not follow-up to see if the viral load results had arrived or not from the laboratory. This tracking sheet really helped us to ensure that the patient's result was entered into their file.”

Daniel Mundiva (Namacurra HFQI Focal Point) discussing Viral Load results with a patient Photo credit: Rui Esmael

According to Daniel Mundiva, the Quality Improvement (QI) Focal Point for the Namacurra Sede HF, “Before the tracking sheet was introduced, fewer people knew their viral load result. There was a long waiting period to learn the result (…). Now with the tracking sheet, if a patient does not have the result, we can track where the patient’s viral load result is. If reception of the result is delayed, we can easily identify the reason.” Daniel emphasized that “Thanks to the tracking sheet, we have almost 100% of VL results returned, hardly any misses. This facilitates the monitoring of patients”.

António Fiscal, the Director of the Namacurra Sede HF, ends by stating: “The introduction of this tracking sheet is of added value.”

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Namacurra

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HIV/AIDS Treatment Options Improve with Quick Lab Results in Zambézia Province

ridingkm — Wed, 13 Nov 2019 19:01:24 +0000

HIV/AIDS Treatment Options Improve with Quick Lab Results in Zambézia Province ridingkm Wed, 11/13/2019 - 13:01 RSS:

FGH Communications Team (in-country)

Dramatic reduction in specimen turnaround time and access to thousands of viral load results offers significant life-saving opportunities

The marked increase in the availability of viral load (VL) results, a critically important laboratory test to monitor the adherence to and effectiveness of combination antiretroviral therapy (ART), has offered significant opportunities for improving the health of thousands of adults and children living with HIV in Zambézia Province, Mozambique. Interventions have been made at various levels of the laboratory sector in recent years, led by the Provincial Directorate of Health of Zambézia (DPS-Z), with the support of Friends in Global Health (FGH), and made possible thanks to funding from the President's Emergency Plan for AIDS Relief (PEPFAR), provided through the Centers for Disease Control and Prevention (CDC).

Viral load analysis measures the amount of HIV RNA in a patient’s blood sample. Knowing an ART-treated person’s viral load helps medical providers assess the effectiveness of a patient's HIV/AIDS treatment. Viral load results below the lower limits of detection indicate that a patient is adherent to their prescribed ART regimen and that their body is responding well to therapy. A high or increasing viral load can be a warning of non-adherence and/or the development of HIV drug resistance. Cele Carlos Vitorino is head of the Molecular Biology Laboratory [MBL] at the Quelimane General Hospital [QGH], the only laboratory in the province equipped to process VL samples.

He tells us, “One of the main objectives of viral load is the monitoring of HIV positive patients’ treatment, so that we can see if it is having an effect or not, in terms of patient adherence.”

In the past, VL samples had to be processed and shipped all the way to the DREAMS laboratory (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe Program) in Maputo. Viral load results could take more than four months to return to the requesting health facility, during which time a patient may have continued to have suboptimal adherence without any follow-up or intervention. Beginning in 2015, with the installation of laboratory equipment at the QGH MBL and the strengthening of the sample referral system, all ART-treated patients from the 196 FGH supported health facilities (HF) in Zambézia Province currently have access to VL services. There has been a dramatic increase in the number of motorcycles in use to support daily VL sample transport from peripheral HFs to District Sede HFs. FGH has also contracted third-party services through CORRE (Correio Expresso de Moçambique – express mail services) for sample transportation from District Sedes to the QGH MBL twice a week. Viral load results are now returned to the ordering HF within an impressive 10 days, an average. A team of three FGH sample managers, three digitizers and a laboratory mentor support the various operations at QGH that enable quality and timely VL results. “In this process, the role of FGH is very innovative and very important for the lab, in terms of interaction with the health facilities,” emphasizes Cele Carlos Vitorino.

In addition, the DisaLink laboratory results system has been installed in all FGH-supported districts except Mulevala to ensure that district-level VL requests are immediately available at QGH. Once results are processed at QGH, they are made available in real-time to the District Sedes, saving time and other additional resources. To this end, FGH has contracted twenty-four digitizers based in the District Sede HFs and other high-volume HFs. The staff support DisaLink systems operations and enter results into OpenMRS, making the results available to the provider to properly inform and guide clinical care decisions for their patients. Today, over 16,000 VL results are provided monthly, compared to approximately 7,000 per month a year ago.

Viral load sample verification
Photo credit: Rui Esmael

Viral load sample registration into DisaLab
Photo credit: Rui Esmael

Viral load sample verification
Photo credit: Rui Esmael

Viral load samples are transported by CORRE
Photo credit: Rui Esmael

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HIV+ people living with an undetectable viral load in Zambézia Province increases

ridingkm — Tue, 13 Aug 2019 20:58:31 +0000

HIV+ people living with an undetectable viral load in Zambézia Province increases ridingkm Tue, 08/13/2019 - 15:58 RSS:

FGH Communications Team (in-country)

Marcos and his wife on their way to the health facility. Photo: Enia Leonardo

Twenty-seven year old Marcos Gabriel lives in Zambézia Province with his wife and three children. To earn his family’s daily bread he dedicates himself to mining, a job that demands health and strength.

“I feel good and do my job normally. I am able to bring food to my family and I'm very happy. The decision I made to start antiretroviral treatment was a good one, because before I felt sick and did not have the strength to work, but now I can do my job; I have improved a lot,” Marcos told us.

About a year ago, Marcos’ situation was quite different; he was weakened by HIV and was unable to work, jeopardizing his ability to take care of his family. Since he decided to accept the advice of health professionals and start HIV treatment in June 2018, his life has inarguably changed for the better.

“In April, when I was asked to do a viral load analysis, I was comfortable because I had already decided to go to the health facility and do whatever it took to improve my health. I was not thinking about myself; I thought about my family. And when they had the result, they called me. I went to the health center and I was told that my viral load was undetectable. I felt very happy, really very happy.”

Plasma HIV RNA, commonly referred to as viral load, is the amount of HIV that can be measured. When that amount is so low it cannot be measured by a blood test (i.e. below the lower limits of detection), it is considered undetectable. Viral load results are one of the most effective ways to measure whether or not HIV treatment is having the desired effect on an individual patient. A viral load exam can contribute to a more realistic picture of a patient’s adherence to their prescribed combination antiretroviral therapy (ART). Viral suppression translates to improved patient health. Undetectable levels of the virus also eliminate the risk that a patient will transmit the virus to their partner (i.e. “undetectable” = “untransmissible” [“U=U”]).

Marcos' wife and children -- Photo: Enia Leonardo

Thanks to United States Government funding, specifically, the President's Emergency Plan for AIDS Relief (PEPFAR) provided through the Centers for Disease Control and Prevention (CDC), FGH has been providing support and special attention to the use of viral load as a way to better verify that patients are correctly adhering to care and treatment, and to offer better medical care, which are fundamental steps towards controlling the epidemic.

Marcos and his wife attend an antenatal consultation. Photo: Enia Leonardo

In all FGH supported districts in Zambézia, there was a significant increase in the use of viral load, both in the number of tests requested and in the proportion of patients with viral suppression. In the last 12 months, 79,525 patients underwent routine viral load testing, of which 59,786 (75.1%) were virally suppressed, representing a significant increase from prior reporting periods.

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