Blog RSS https://www.vumc.org/friends-in-global-health/ en HIV treatment continues for thousands during the COVID-19 pandemic https://www.vumc.org/friends-in-global-health/success-stories/hiv-treatment-continues-thousands-during-covid-19-pandemic <span class="field field--name-title field--type-string field--label-hidden">HIV treatment continues for thousands during the COVID-19 pandemic</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 08/30/2021 - 09:30</span> <a href="/friends-in-global-health/blog-post-rss/65" class="feed-icon" title="Subscribe to HIV treatment continues for thousands during the COVID-19 pandemic"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p> </p> <figure style="width: 300px; float: left; margin-right: 20px; font-size: 90%"><img alt="patient " data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss3.2z_21.png" class="align-right" /> <figcaption>Melo Melo, Namacurra’s main health facility (HF) interim clinical Director analyzing a patient’s card during a consultation</figcaption> </figure> <blockquote> <p>“This intervention allows us to recover every single patient that had interrupted treatment.” Melo Melo, Interim Clinical Director of Namacurra Health Facility.</p> </blockquote> <p>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.”</p> <p>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).</p> <p>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.”</p> <p>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.”</p> <figure style="width: 400px; float: left; margin-right: 20px; font-size: 90%"><img alt="patient " data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss3.1_21.png" class="align-right" /> <figcaption>Clinical officer providing ART medication to Carimo Mamudo Aliz during a community distribution of ART</figcaption> </figure> <p>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).</p> <p> </p> <p>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.</p> <figure style="width: 350px; float: left; margin-right: 20px; font-size: 90%"><img alt="patient " data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss3.3_21.png" class="align-right" /> <figcaption>Macuse’s HF director analyzing registration of patients that return to the HF after community distribution of ART</figcaption> </figure> <p>Considering the positive impact to 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.</p> <p>These results were achieved though 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.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 30 Aug 2021 14:30:46 +0000 ridingkm 65 at https://www.vumc.org/friends-in-global-health Increased access to Cervical Cancer Screening Improves Women’s lives in Zambézia https://www.vumc.org/friends-in-global-health/success-stories/increased-access-cervical-cancer-screening-improves-womens-lives-zambezia <span class="field field--name-title field--type-string field--label-hidden">Increased access to Cervical Cancer Screening Improves Women’s lives in Zambézia</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 05/31/2021 - 09:25</span> <a href="/friends-in-global-health/blog-post-rss/64" class="feed-icon" title="Subscribe to Increased access to Cervical Cancer Screening Improves Women’s lives in Zambézia"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><figure style="width: 350px; float: left; margin-right: 20px; font-size: 90%"><img alt="mother and daughter" data-entity-type="" data-entity-uuid="" height="488" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss2.3_21.png" width="366" /> <figcaption>Teresa Manuel S. Pinto preparing food with her daughter</figcaption> </figure> <h4 style="margin-left: 66px;">“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.”</h4> <p>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 <a href="#_ftn1" name="_ftnref1" title="" id="_ftnref1">[1]</a>, 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.”</p> <figure style="width: 300px; float: left; margin-right: 20px; font-size: 90%"><img alt="health care worker" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss2.1_21.png" /> <figcaption>4 de Dezembro Health Facility director Bernardete Bernardo Segundo consulting Cervical Cancer images</figcaption> </figure> <p>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.</p> <p>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.”</p> <blockquote> <p>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.”</p> </blockquote> <figure style="width: 350px; float: right; margin-left: 20px; font-size: 90%"><img alt="health care worker" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss2.2_21.png" /> <figcaption>4 de Dezembro Health Facility director Bernardete Bernardo Segundo providing instructions on Cervical Cancer related medical instruments to a maternal and child health nurse</figcaption> </figure> <p>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.</p> <p>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.</p> <p>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.</p> <div> <hr size="1" /> <div id="ftn1"> <p><a href="#_ftnref1" name="_ftn1" title="" id="_ftn1">[1]</a> <a href="https://www.unaids.org/en/resources/presscentre/featurestories/2019/may/20190531_cervical-cancer-hiv">https://www.unaids.org/en/resources/presscentre/featurestories/2019/may…</a></p> </div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 31 May 2021 14:25:58 +0000 ridingkm 64 at https://www.vumc.org/friends-in-global-health Towards the Elimination of Mother-to-Child HIV Transmission https://www.vumc.org/friends-in-global-health/success-stories/towards-elimination-mother-child-hiv-transmission <span class="field field--name-title field--type-string field--label-hidden">Towards the Elimination of Mother-to-Child HIV Transmission</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Sun, 02/28/2021 - 09:17</span> <a href="/friends-in-global-health/blog-post-rss/63" class="feed-icon" title="Subscribe to Towards the Elimination of Mother-to-Child HIV Transmission"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><blockquote> <p>“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</p> </blockquote> <p>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%.</p> <figure style="width: 400px; float: left; margin-right: 20px; font-size: 90%"><img alt="mother and child" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss1.1_21.png" /> <figcaption>A patient having a conversation with a Mentor Mother</figcaption> </figure> <p>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.</p> <p>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.</p> <p>Dr. Tilvério Gasolina, Clinical Director of the 17 de Setembro HF, praised FGH support, specifically the technical and mentoring support provided to HFs.</p> <blockquote> <p>“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.”</p> </blockquote> <p>In addition, Dr. Atanásio Fiscal, the Director of the Namacurra Sede HF, emphasizing the clinical-community linkages component offered the following statement,</p> <blockquote> <p>“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."</p> </blockquote> <figure style="width: 400px; float: right; margin-left: 20px; font-size: 90%"><img alt="health care worker" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss1.2_21.png" /> <figcaption>Namacurra HF Director going through patient files</figcaption> </figure> <p>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.  </p> <p>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.</p> <p>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.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Sun, 28 Feb 2021 15:17:38 +0000 ridingkm 63 at https://www.vumc.org/friends-in-global-health Clinical Advisor’s Commitment Leads to a More Than Threefold Increase in Patients Completing Tuberculosis Preventive Therapy (TPT) https://www.vumc.org/friends-in-global-health/success-stories/clinical-advisors-commitment-leads-more-threefold-increase-patients-completing <span class="field field--name-title field--type-string field--label-hidden">Clinical Advisor’s Commitment Leads to a More Than Threefold Increase in Patients Completing Tuberculosis Preventive Therapy (TPT)</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 11/20/2020 - 16:13</span> <a href="/friends-in-global-health/blog-post-rss/49" class="feed-icon" title="Subscribe to Clinical Advisor’s Commitment Leads to a More Than Threefold Increase in Patients Completing Tuberculosis Preventive Therapy (TPT)"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><blockquote> <p class="text-align-right">“It’s valuable work; if Clinical Advisors ceased to exist, data would fall.”<br /> Timóteo Makenda<br /> Quelimane District HIV and STI Focal Point</p> </blockquote> <p> </p> <p>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.</p> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="patient " data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss_q4_3.jpg" class="align-right" /> <figcaption>Salvador dos Santos (Quelimane National TB Control Program supervisor) attending a patient Photographer: Abú Choe</figcaption> </figure> <p>Simultaneously, new data and care &amp; 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.</p> <p>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 &amp;Evaluation team. The successful implementation of this SOP was only possible thanks to the engagement and invaluable contributions of the Clinical Advisors.</p> <blockquote> <p>"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.</p> </blockquote> <figure style="width: 300px; float: left; margin-right: 20px; font-size: 90%"><img alt="patient " data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss_q4_1.jpg" class="align-left" /> <figcaption>Tânia Mulhanga (FGH Clinical Advisor) explaining TB medication regime to a patient Photographer: Antonio Ambelikola</figcaption> </figure> <p>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.</p> <blockquote> <p>“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.</p> </blockquote> <figure style="width: 300px; float: left; margin-left: 20px; font-size: 90%"><img alt="patient " data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss_q4_2.jpg" class="align-left" /> <figcaption>Timoteo Makenda (Quelimane HIV and STI focal point) analyzing TB data Photographer: Abú Choe</figcaption> </figure> <p align="right" style="text-align:right"> </p> </div> <div> <strong>Tags</strong> <div> <div><a href="/friends-in-global-health/success-stories?tag=9" hreflang="en">Quelimane</a>, <a href="/friends-in-global-health/success-stories?tag=11" hreflang="en">HIV/Tuberculosis</a></div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Fri, 20 Nov 2020 22:13:31 +0000 ridingkm 49 at https://www.vumc.org/friends-in-global-health FGH Rapidly Expands 3-month ART Dispensation during the COVID-19 Pandemic https://www.vumc.org/friends-in-global-health/success-stories/fgh-rapidly-expands-3-month-art-dispensation-during-covid-19-pandemic <span class="field field--name-title field--type-string field--label-hidden">FGH Rapidly Expands 3-month ART Dispensation during the COVID-19 Pandemic </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 09/15/2020 - 16:40</span> <a href="/friends-in-global-health/blog-post-rss/48" class="feed-icon" title="Subscribe to FGH Rapidly Expands 3-month ART Dispensation during the COVID-19 Pandemic "> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p style="margin-bottom: 11px;">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. </p> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="patient " data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss_Q3_1.jpg" class="align-right" /> <figcaption>A patient collects three-month’s worth of ARV medication at Maquival Sede Health Facility Photographer: Alferes Ledesse</figcaption> </figure> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <figure style="width: 335px; float: left; margin-right: 10px; font-size: 90%"><img alt="patient" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss_Q3_2.jpg" class="align-left" /> <figcaption>A health counselor phones a patient to come collect his ARV medication, at 24 de Julho Health Facility in Quelimane Photographer: Josefina Supinho</figcaption> </figure> <p>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. </p> <p> </p> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="patient" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss_Q4_4.jpg" class="align-right" /> <figcaption>A patient collects three-month’s worth of ARV medication at Maquival Sede Health Facility Photographer: Alferes Ledesse</figcaption> </figure> <p>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.</p> <figure style="width: 335px; float: left; margin-right: 10px; font-size: 90%"><img alt="patient" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/ss_Q3_3.jpg" class="align-left" /> <figcaption>A patient receiving counseling about receiving three-month’s worth of ARV medication, at 24 de Julho health facility in Quelimane Photographer: Josefina Supinho</figcaption> </figure> <p>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).    </p> <p>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.  </p> <p style="text-align:justify"> </p> </div> <div> <strong>Tags</strong> <div> <div><a href="/friends-in-global-health/success-stories?tag=8" hreflang="en">COVID-10</a>, <a href="/friends-in-global-health/success-stories?tag=9" hreflang="en">Quelimane</a>, <a href="/friends-in-global-health/success-stories?tag=10" hreflang="en">Pharmacy Services</a></div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 15 Sep 2020 21:40:13 +0000 ridingkm 48 at https://www.vumc.org/friends-in-global-health Innovative intervention within Triage Ward and Emergency Rooms Leads to Impressive Preliminary HIV Testing Services Results https://www.vumc.org/friends-in-global-health/success-stories/innovative-intervention-within-triage-ward-and-emergency-rooms-leads-impressive <span class="field field--name-title field--type-string field--label-hidden">Innovative intervention within Triage Ward and Emergency Rooms Leads to Impressive Preliminary HIV Testing Services Results </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 06/03/2020 - 17:35</span> <a href="/friends-in-global-health/blog-post-rss/46" class="feed-icon" title="Subscribe to Innovative intervention within Triage Ward and Emergency Rooms Leads to Impressive Preliminary HIV Testing Services Results "> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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</p> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="Marcos and wife" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/HTC-counselor.jpg" /> <figcaption>Vilma Santos, Maquival Sede HTC counselor, counselling a patient. Photo credit: Rui Esmael</figcaption> </figure> <p>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.”</p> <blockquote> <p>“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.”</p> </blockquote> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="Marcos and wife" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/record_review.jpg" /> <figcaption>Vilma Santos reviews her patient’s records at Maquival Sede Health Center. Photo credit: Rui Esmael</figcaption> </figure> <p>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.</p> <blockquote>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. <p> </p> </blockquote> <p>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.”</p> <p>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.</p> <figure style="width: 335px; float: right; margin-left: 20px; font-size: 90%"><img alt="Marcos and wife" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/madeira.jpg" width="296" /> <figcaption>Maria Madeira, Maquival Sede Health Center Clinical Director, assessing a patient. Photo credit: Margareth Gonsalves</figcaption> </figure> <p>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.</p> <p>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.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 03 Jun 2020 22:35:09 +0000 ridingkm 46 at https://www.vumc.org/friends-in-global-health 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 https://www.vumc.org/friends-in-global-health/success-stories/implementation-standardized-operating-procedure-successfully-improved-receipt-viral <span class="field field--name-title field--type-string field--label-hidden">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 </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 02/14/2020 - 13:24</span> <a href="/friends-in-global-health/blog-post-rss/47" class="feed-icon" title="Subscribe to 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 "> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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%.</p> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="António Fiscal" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/Anto%CC%81nio%20Fiscal%20.jpg" /> <figcaption>António Fiscal (Namacurra HF Director) reviewing a patient’s Viral Load results Photo credit: Rui Esmael</figcaption> </figure> <p>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.</p> <p>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:</p> <figure style="width: 600px; float: left; margin-left: 20px; font-size: 90%"><img alt="chart" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/cop19q1_figure1.png" /> <figcaption>Figure 1: Namacurra Sede Health Facility Pregnant and Lactating Women Viral Load Cascade before and after implementation of the SOP</figcaption> </figure> <p>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%.</p> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="Jair Fataha" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/Jair_Fataha.jpg" /> <figcaption>Jair Fataha (FGH Clinical Advisor) and Sisinio Jorge (Patient Receptionist) assessing the completeness of Viral Load Results in the tracking sheet credit: Rui Esmael</figcaption> <p> </p> </figure> <p>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.”</p> <p> </p> <figure style="width: 300px; float: right; margin-left: 20px; font-size: 90%"><img alt="Daniel Mundiva" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/Daniel%20Mundiva.jpg" /> <figcaption>Daniel Mundiva (Namacurra HFQI Focal Point) discussing Viral Load results with a patient Photo credit: Rui Esmael</figcaption> </figure> <p>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”.</p> <blockquote>António Fiscal, the Director of the Namacurra Sede HF, ends by stating: “The introduction of this tracking sheet is of added value.”</blockquote> </div> <div> <strong>Tags</strong> <div> <div><a href="/friends-in-global-health/success-stories?tag=4" hreflang="en">Namacurra</a></div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Fri, 14 Feb 2020 19:24:01 +0000 ridingkm 47 at https://www.vumc.org/friends-in-global-health HIV/AIDS Treatment Options Improve with Quick Lab Results in Zambézia Province https://www.vumc.org/friends-in-global-health/success-stories/hivaids-treatment-options-improve-quick-lab-results-zambezia-province <span class="field field--name-title field--type-string field--label-hidden">HIV/AIDS Treatment Options Improve with Quick Lab Results in Zambézia Province</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 11/13/2019 - 13:01</span> <a href="/friends-in-global-health/blog-post-rss/35" class="feed-icon" title="Subscribe to HIV/AIDS Treatment Options Improve with Quick Lab Results in Zambézia Province"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><blockquote> <p>Dramatic reduction in specimen turnaround time and access to thousands of viral load results offers significant life-saving opportunities</p> </blockquote> <div class="row"> <div class="col-md-6"> <p>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).</p> <p>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.</p> <blockquote> <p>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.”</p> </blockquote> <p>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.</p> <p>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.</p> </div> <div> <p><img alt="VL processing" data-entity-type="" data-entity-uuid="" height="199" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/02%20Processamento%20de%20Carga%20Viral.jpg" width="298" /></p> <p>Viral load sample verification<br /> Photo credit: Rui Esmael</p> <p><img alt="VL sample" data-entity-type="" data-entity-uuid="" height="200" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/Cadastro%20de%20amostras%20de%20VL%20no%20disalab.jpg" width="302" /></p> <p>Viral load sample registration into DisaLab<br /> Photo credit: Rui Esmael</p> <p><img alt="VL Sample" data-entity-type="" data-entity-uuid="" height="201" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/Verificac%CC%A7a%CC%83o%20das%20amostras%20de%20VL.jpg" width="304" /></p> <p>Viral load sample verification<br /> Photo credit: Rui Esmael</p> <p><img alt="CORRE Transport" data-entity-type="" data-entity-uuid="" height="214" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/01%20Cadastro%20de%20amostras%20de%20VL%20no%20disalab.jpg" width="305" /></p> <p>Viral load samples are transported by CORRE<br /> Photo credit: Rui Esmael</p> </div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 13 Nov 2019 19:01:24 +0000 ridingkm 35 at https://www.vumc.org/friends-in-global-health HIV+ people living with an undetectable viral load in Zambézia Province increases https://www.vumc.org/friends-in-global-health/success-stories/hiv-people-living-undetectable-viral-load-zambezia-province-increases <span class="field field--name-title field--type-string field--label-hidden">HIV+ people living with an undetectable viral load in Zambézia Province increases </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 08/13/2019 - 15:58</span> <a href="/friends-in-global-health/blog-post-rss/36" class="feed-icon" title="Subscribe to HIV+ people living with an undetectable viral load in Zambézia Province increases "> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2> </h2> <figure style="width: 335px; float: right; margin-left: 20px; font-size: 90%"><img alt="Marcos and wife" data-entity-type="" data-entity-uuid="" height="403" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/cop18-q3.4.jpg" width="296" /> <figcaption>Marcos and his wife on their way to the health facility. Photo: Enia Leonardo</figcaption> </figure> <p>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.</p> <blockquote> <p>“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.</p> </blockquote> <p>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.</p> <blockquote> <p>“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.”</p> </blockquote> <p>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”]).</p> <figure style="width: 335px; float: right; margin-left: 20px; font-size: 90%"><img alt="Marcos's wife and children -- Photo: Enia Leonardo" data-entity-type="" data-entity-uuid="" height="262" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/cop18-q3.5.jpg" width="350" /> <figcaption>Marcos' wife and children -- Photo: Enia Leonardo</figcaption> </figure> <p>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.<br /> <br />  </p> <figure style="width: 335px; float: left; margin-right: 20px; font-size: 90%"><img alt="Marcos and wife at appointment" data-entity-type="" data-entity-uuid="" height="233" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/cop18-q3.2.jpg" width="309" /><figcapture>Marcos and his wife attend an antenatal consultation. Photo: Enia Leonardo</figcapture></figure> <p>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.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 13 Aug 2019 20:58:31 +0000 ridingkm 36 at https://www.vumc.org/friends-in-global-health Early infant diagnosis point-of-care device provides early HIV diagnosis in children https://www.vumc.org/friends-in-global-health/success-stories/early-infant-diagnosis-point-care-device-provides-early-hiv-diagnosis-children <span class="field field--name-title field--type-string field--label-hidden">Early infant diagnosis point-of-care device provides early HIV diagnosis in children</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 05/23/2019 - 17:07</span> <a href="/friends-in-global-health/blog-post-rss/37" class="feed-icon" title="Subscribe to Early infant diagnosis point-of-care device provides early HIV diagnosis in children"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p> </p> <figure style="width: 335px; float: right; margin-left: 20px; font-size: 90%"><img alt="Point of care device" data-entity-type="" data-entity-uuid="" height="275" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/Point-of-Care%20machine.jpg" width="373" /> <figcaption>Point-of-Care machine Photo credit: Mariana Lobo</figcaption> </figure> <p>The early infant diagnosis point-of-care (EID POC) device provides early HIV diagnosis in children, allowing for almost immediate testing results. In the past, infant HIV diagnostic tests could only be performed in Quelimane. Samples were collected at the district health facilities and transported all the way to the provincial capital, taking weeks, sometimes more than one month to return.</p> <p>Jordina Moreira, a Maternal Child Health Nurse working with the Maganja da Costa District Health Directorate (DDS) told us, “Since we received the HIV Early Infant Diagnosis Point-of-Care Machine in October 2018, the story has changed here in Maganja da Costa. Previously the results of the analysis of children were slow to arrive. It used to take fifteen to thirty days. Now it’s no longer like this - the results come out the same day."</p> <figure style="width: 335px; float: left; margin-right: 20px; font-size: 90%"><img alt="Nurse Jordina Moreira" data-entity-type="" data-entity-uuid="" height="258" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/NurseJordinaMoreira.jpg" width="346" /> <figcaption>Nurse Jordina Moreira Photo: Mariana Lobo</figcaption> </figure> <p>Ana Lampeão, who works for Friends in Global Health (FGH), is a Health Advisor in the maternal and child health sector. She explained to us that the delayed test results contributed to late combination antiretroviral therapy (ART) initiation in children. In the past, after positive DNA PCR results came back from Quelimane, weeks after the sample had originally been collected, even more time was lost while the health facility attempted to find the child again, to deliver their test results, and then enroll the child in care. The combined delay in delivering positive results and beginning treatment sometimes led to tragic outcomes. There were times when the results arrived so late the child was already severely ill or had even died.</p> <p> </p> <p> </p> <blockquote> <p>“Before the arrival of the machine, we lost two children because of the delay in the results. The first child lost his life even before the arrival of the result, and the other started the treatment, but it was too late to conquer the disease.”</p> </blockquote> <p>Now, with the EID POC device in the district, it takes just one hour to get the child's test results. If the test result is positive, the child can commence ART that same day.</p> <blockquote> <p>“Now that the result takes only an hour, things have gotten better. Everything happens with the family present in the health facility. Everyone receives the information in the moment. If the result is positive, the child begins treatment. We no longer need to look for the child's location.</p> </blockquote> <figure style="width: 279px; float: right; margin-left: 20px; font-size: 90%"><img alt="Leonilde and her daughter were able to receive test results on the same day." data-entity-type="" data-entity-uuid="" height="209" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/samedayresults.jpg" width="279" /> <figcaption>Leonilde and her daughter were able to receive test results on the same day. Photo credit: Mariana Lobo</figcaption> </figure> <p>The EID POC typically reads eight infant DNA PCR tests per day. The monthly collection goal is 48 forty-eight DNA PCR tests, but this target is sometimes exceeded, performing more than 50 DNA PCR results on some days. From October 2018 through March 31st, 2019, 231 infants were tested using the new EID POC devices, 31 of whom had a positive result and are now receiving potentially life-saving ART.</p> <p>This work is made possible thanks to the collaboration between Vanderbilt University Medical Center (VUMC), Friends in Global Health (FGH), the CDC, and the District Health Directorate (DDS) with funds from The President's Emergency Plan For AIDS Relief (PEPFAR).</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 23 May 2019 22:07:09 +0000 ridingkm 37 at https://www.vumc.org/friends-in-global-health Mentor Mothers promote the birth of HIV-uninfected children in Quelimane. https://www.vumc.org/friends-in-global-health/success-stories/mentor-mothers-promote-birth-hiv-uninfected-children-quelimane <span class="field field--name-title field--type-string field--label-hidden">Mentor Mothers promote the birth of HIV-uninfected children in Quelimane.</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 02/28/2019 - 10:55</span> <a href="/friends-in-global-health/blog-post-rss/19" class="feed-icon" title="Subscribe to Mentor Mothers promote the birth of HIV-uninfected children in Quelimane."> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><blockquote> <p>“I am very happy because my daughter was born HIV free,” says Leocádia Adelino, a resident of Maquivale Sede Administrative Post, in Quelimane District, Zambézia Province, Mozambique.</p> </blockquote> <div class="row"> <div class="col-md-6"> <p>Leocádia has lived with HIV since 2016. She has four children, ages 15, 13, 5, and almost 2. All of her children, including the youngest, are free of HIV.</p> <p>Leocádia discovered that she was HIV-positive during her most recent pregnancy. Her husband had abandoned her at the time. This is when Lodovina Nazaré, a 51-year-old Mentor Mother, came into her life. “At that time, I began to accompany Leocádia, up to the birth of her daughter in March 2017.” Leocádia has been receiving combination antiretroviral therapy (ART) at Maquivale Sede Health Center ever since. “Today, it was definitively confirmed that the child does not have HIV and I am very happy! Even after that, I continue to accompany her in taking her antiretrovirals,” Lodovina tells us.</p> <p>Mentor Mothers are trained volunteers who form support groups of HIV-positive pregnant women and advise them on how to correctly take their prescribed ART regimen.  </p> <blockquote> <p>“Madam Lodovina always encouraged me to take the medication. She used to say, ‘You must take the medicines correctly so that your child is born without HIV and so that you stay well too.’ Today my daughter is growing well, without HIV, and I continue to take my antiretrovirals to stay healthy,” Leocádia told us.</p> </blockquote> <p>Lodovina has been a Mentor Mother since 2017 and has received extensive training and support from FGH. Mentor Mothers are, by definition, women living with HIV. Through their lives and testimonies, they support other HIV-positive and pregnant women throughout their pregnancies and lactation period by accompanying them to antenatal and child-at-risk consultations and encouraging them to adhere to their prescribed ART regimens and remain retained in HIV care at their respective health facilities. The Mentor Mother strategy can help avoid the abandonment of treatment by HIV-positive mothers and, consequently, reduce the vertical transmission of HIV to infants.</p> <p>FGH supports Mentor Mothers by providing continuous training, monetary incentives ​​and work materials such as notepads, pens, t-shirts for identification during community work, as well as bicycles to travel throughout their community to conduct their work.</p> <p>Joaquim Razão, the director of Maquivale Sede Health Facility Director, said that one of the greatest gains the Mentor Mother Strategy has brought to the health facility he manages is the care and follow-up to the patients. The director also points out that Mentor Mothers can reach places where most health workers cannot. He notes that Mentor Mothers have a strong communication link with the community. They help to convey key messages and empower the population to adhere to their ART regimens.</p> <p>Implementation of the Mentor Mother Strategy by the Provincial Health Directorate of Zambézia began in 2017, with FGH support. It arose from the need to follow up with HIV-positive pregnant and lactating women during the critical window of time during which the mother can transmit HIV to her child. Since then, 784 Mentor Mothers have already been trained in Zambézia Province. They currently support 16,044 pregnant and lactating women. From October 2017 through September 2018, 392 HIV-positive pregnant women were newly enrolled and followed at Maquivale Sede Health Facility, with a retention rate of 78%.</p> <p>FGH Maternal and Child Heath regional coordinator, Esperança Chimbe, said that in addition to its focus on the retention of pregnant and lactating women, the strategy also contributes to improvements in viral load suppression.</p> <p>Leocádia managed to have a daughter free of HIV thanks to the work of the Quelimane District Health, Women and Social Service (SDSMAS), in partnership with FGH, which since October 2017 have been working together to fight HIV/AIDS. Work done through this partnership is made possible through funds from the United States President's Emergency Plan for AIDS Relief (PEPFAR) provided by the Centers for Disease Control and Prevention (CDC).</p> </div> <div> <p><img alt="Leocádia-and-daughter" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/leocadia_raquia.jpg" width="300" /></p> <p>Leocádia and her daughter, Raquia.<br /> Photographer: Abú Choe</p> <p><img alt="Leocadia-cooking" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/Leocadia.jpg" width="300" /></p> <p>Leocádia cooking in her backyard<br /> Photographer: Abú Choe</p> <p><img alt="Leocádia-and-Lodovina" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/lodovina.jpg" width="300" /></p> <p>Leocádia and Lodovina<br /> Photographer: Abú Choe</p> <p><img alt="Joaquim Razão" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/razao.jpg" width="300" /></p> <p>Joaquim Razão, Namacurra Sede Health Center<br /> Photographer: Cleófas Viagem</p> </div> </div> </div> <div> <strong>Tags</strong> <div> <div><a href="/friends-in-global-health/success-stories?tag=9" hreflang="en">Quelimane</a>, <a href="/friends-in-global-health/success-stories?tag=3" hreflang="en">PMTCT</a>, <a href="/friends-in-global-health/success-stories?tag=6" hreflang="en">Mentor Mothers</a></div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 28 Feb 2019 16:55:56 +0000 ridingkm 19 at https://www.vumc.org/friends-in-global-health Novel Strategy Improves the Identification of People Living with HIV in Namacurra​ https://www.vumc.org/friends-in-global-health/success-stories/novel-strategy-improves-identification-people-living-hiv-namacurra <span class="field field--name-title field--type-string field--label-hidden">Novel Strategy Improves the Identification of People Living with HIV in Namacurra​</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 11/13/2018 - 16:34</span> <a href="/friends-in-global-health/blog-post-rss/20" class="feed-icon" title="Subscribe to Novel Strategy Improves the Identification of People Living with HIV in Namacurra​"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2> </h2> <figure style="width: 335px; float: left; margin-right: 20px; font-size: 90%"><img alt="Jair Fataha provides technical support." data-entity-type="" data-entity-uuid="" height="402" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/Picture2.jpg" width="328" /> <figcaption>FGH Clinical Advisor, Jair Fataha, giving technical support to a health technician (Sérgio Ali) at Namacurra Sede Health Center. Photographer: Cleófas Viagem</figcaption> </figure> <p>In May 2018, Friends in Global Health’s (FGH) multidisciplinary team began the implementation of a strategy aimed at optimizing provider-initiated HIV counseling and testing; commonly referred to as PICT.  This strategy consists of provider orientation, the weekly monitoring of performance, the elaboration of improvement plans, and the implementation of specific interventions, namely, the prioritization of HIV counseling and testing in high yield service delivery points such as the pediatric and adult inpatient wards, the emergency room, and the triage ward settings. The novel strategy was initiated in Namacurra District where the FGH multidisciplinary team provides support to the Namacurra District Health Directorate (DDS) in its fight against HIV and AIDS. Such support is made possible by funding from the United States government (USG); specifically, the President’s Emergency Plan for AIDS Relief (PEPFAR) funding from the Centers for Disease Control and Prevention (CDC).</p> <p>The three PICT interventions have resulted in significant increases in the number of new HIV-positive persons being identified within the district. Between May and August 2018, 11,684 persons were counseled and tested for HIV through the PICT optimization strategy in the Namacurra District. Of those tested, 1,246 (10.7%) were diagnosed HIV-positive, of which a very high proportion (94%) were enrolled in care and linked to potentially life-saving combination antiretroviral therapy (ART) services. During the same period in 2017, before the implementation of this PICT optimization strategy in Namacurra, a significantly lower total number of persons (n = 3,796) underwent provider-initiated HIV counseling and testing. At this time, 399 persons were newly diagnosed with HIV, of which a lower proportion (79%) were successfully linked to ART services.</p> <figure style="width: 341px; float: right; margin-left: 20px; font-size: 90%"><img alt="FGH planning session" data-entity-type="" data-entity-uuid="" height="227" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/fgh%20health.jpg" width="341" /> <figcaption>From left to right: FGH Health Counseling and Testing Officer, Chelsio Mabote, Namacurra Chief Medical Officer, Elias Simão, and FGH Clinical Advisor, Jair Fataha, at a PICT monitoring planning session at the Namacurra Sede Health Center. Photographer: Cleófas Viagem</figcaption> </figure> <p>This increase in performance is the result of deliberate action taken during the most recent FGH quarterly meeting (May 2018), when it was decided that specific large volume health facilities (HFs) need to establish weekly targets for the number of persons newly identified with HIV by service delivery point. FGH leadership felt that in order to maximize PICT, a more intensive (i.e. weekly) monitoring approach would be necessary.  For Namacurra District, this intensive monitoring strategy was implemented in the 5 HFs where the PICT optimization strategy was being implemented and that have the largest goals in terms of persons newly initiated on ART, specifically the Namacurra Sede, Macuse, Mixixine, Furquia, and Mbaua HFs.<br />  </p> <figure style="width: 330px; float: left; margin-right: 20px; font-size: 90%"><img alt="Chelsio Mabote provides technical support." data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/HTC%20officer.jpg" width="330" /> <figcaption>FGH HTC Officer, Chelsio Mabote, giving technical support to a health adviser at Namacurra Sede Health Center. Photographer: Cleófas Viagem</figcaption> </figure> <p>FGH Namacurra’s dynamic and passionate team, led by the District Clinical Advisor, Jair Fataha, took the orientation seriously.</p> <p>With this intensive monitoring strategy, factors contributing to suboptimal testing volumes/practices, and consequently to the low numbers of new HIV-positive persons, are detected early and measures for addressing the problems can be adopted in a timely manner so that by the end of each week the goals can be attained.</p> <p>FGH’s Health Counseling and Testing Officer, Chelsio Mabote, who provides technical support to health counselors for reaching Namacurra District’s goals, finds even more benefits in the weekly monitoring of the PICT.</p> <blockquote>Changes do not go unnoticed by the district health authorities. "FGH’s level of collaboration with the district’s health directorate is to be prized. FGH has been very supportive of the implementation of strategies to improve our performance," says the Chief Medical Officer, Elias Simão, in reference to the weekly PICT optimization strategy monitoring that is done in coordination with health authorities.</blockquote> <p>Weekly PICT monitoring is an FGH strategy that, since May 2018, is being implemented in all 113 supported districts within Zambézia Province, with the focus being on the 33 HFs having the largest number of patients currently receiving ART.</p> <figure style="width: 341px; float: right; margin-left: 20px; font-size: 90%"><img alt="Namacurra Sede Health Center" data-entity-type="" data-entity-uuid="" height="221" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/sede%20HC.jpg" width="331" /> <figcaption>Namacurra Sede Health Center. Photographer: Cleófas Viagem</figcaption> </figure> <p>For each HF, a target is set for new HIV positive patients to be identified weekly. The goal is based on the average adult and pediatric patient volumes within the highest yield service delivery points (i.e. emergency room, triage and inpatient medical wards) where this is being implemented.<br /> <br /> Namacurra is the district that has shown the most impressive results with this new approach, but FGH looks forward to continued successes from this intensive monitoring strategy as it is implemented in other supported health facilities. Despite still being in a pilot phase, weekly PICT monitoring has already contributed to the identification of 4,867 new HIV-positive patients between May and August 2018, which corresponds to 32% of all new HIV-positive patients being identified in Zambézia Province in the period of evaluation. </p> </div> <div> <strong>Tags</strong> <div> <div><a href="/friends-in-global-health/success-stories?tag=4" hreflang="en">Namacurra</a></div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Tue, 13 Nov 2018 22:34:16 +0000 ridingkm 20 at https://www.vumc.org/friends-in-global-health District in Transformation: Expanded HIV Care and Treatment Service in Quelimane Takes Teamwork https://www.vumc.org/friends-in-global-health/success-stories/district-transformation-expanded-hiv-care-and-treatment-service-quelimane-takes <span class="field field--name-title field--type-string field--label-hidden">District in Transformation: Expanded HIV Care and Treatment Service in Quelimane Takes Teamwork</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 02/05/2018 - 16:47</span> <a href="/friends-in-global-health/blog-post-rss/21" class="feed-icon" title="Subscribe to District in Transformation: Expanded HIV Care and Treatment Service in Quelimane Takes Teamwork"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in country) </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Belito Adolfo has been working for Friends in Global Health (FGH) since 2014. He was promoted to District Coordinator in January 2017, just as VUMC/FGH began supporting the Quelimane District. This new position was the biggest challenge of his professional career. In his new role he works with larger, urban health facilities handling higher patient volumes. With the increased responsibilities, he recognizes the importance of his work and being team member.</p> <blockquote> <p>“Every day, as soon as I get to my office, I ensure the availability of vehicles to transport the FGH technical staff to the health facilities. Afterwards I call every health facility to see who is present, checking to see if teams have all the needed working supplies. There are multiple tasks that have to be completed in a very short period of time,” Adolfo says.</p> </blockquote> <p>But this change is not easy. Due to the district’s large patient population, VUMC/FGH has established three multidisciplinary teams to intensify technical support. Each multidisciplinary team includes clinical advisors, mother and child health officers, psychosocial support officers, pharmacy and laboratory technicians, community health officers, monitoring &amp; evaluation officers, counselors and volunteers. <strong>They all work together to create a strong network of support for the district health authority.</strong></p> <p>VUMC/FGH has installed 7 pre-fabricated units to provide space for several services, such as HIV counseling and testing, tuberculosis (TB) screening and care, and psychosocial support services. VUMC/FGH has also introduced new systems which have resulted in health service improvements: placement of counselors at numerous testing points in the health facilities to increase the number of identified HIV+ individuals; improved logistics for the transportation of blood samples to Quelimane’s laboratory to reduce turnaround time; improvements in the medication supply chain minimizing stock-outs of essential medications; and the establishment of a system for preventive home visits to patients who have initiated ART to improve retention in care rates. There is additionally a multitude of information, education, and communication (IEC) activities, such as the installation of televisions at 9 health facilities with educational messages being played on a continuous loop and the operation of a Multimedia Mobile Unit (MMU) in function for the sole purpose of increasing demand for health services.</p> <p>Dr. Julieta Matsimbe, VUMC/FGH’s Director of Clinical Implementation, has been instrumental to the team’s success in Quelimane District. She explains continuous and honest communication among her colleagues has been one of the secrets of the great rapport and solidarity the team has established over a relatively short period of time.  </p> <blockquote> <p>“We have daily coordination meetings reinforcing the message that all team members support the same district,” Adolfo says. “One team’s success is everybody’s success. Whenever we identify something that is working well in one team, I make sure to have the other teams analyze if it is also possible to implement at the health facilities they support.”</p> </blockquote> <p>The delivery of HIV and TB related services in Quelimane District still faces a number of challenges, but the VUMC/FGH team has made significant progress towards controlling the HIV epidemic. During the 2017 calendar year alone, 82,547 people received HIV counseling and testing services in supported health facilities of Quelimane district. 25,773 individuals were tested between October-December 2017 alone. A total of 3,300 individuals started potentially life-saving combination antiretroviral therapy (ART) between October – December 2017, which is up from 2,267 during the same quarter in 2016 (46% increase). The number of individuals currently on ART increased in 2017 by 35%, from 24,258 in December 2016 to 32,863 in December 2017.</p> <p>These facts do not go by unnoticed by the Quelimane District health authorities:</p> <blockquote> <p>“FGH has arrived at an opportune time… In the area of technical assistance we have more psychologists, more peer educators, and other professionals who assist in the ART services,” director Eduardo Zezema tells us.</p> </blockquote> <p>The Director emphasizes the support VUMC/FGH has been providing towards pharmacy, laboratory, and infrastructure rehabilitation. He also highlights in particular the impact of VUMC/FGH’s work towards the implementation of the Test-and-Start strategy, specifically initiating ART in all HIV positive persons regardless of their immune status (CD4+ cell count).</p> <p>“We are pleased because we have been able to get more patients enrolled on ART at the health facilities, where we are implementing the Test and Start strategy,” concludes Zezema.</p> <p>Thanks to VUMC/FGH’s team spirit and commitment, we have been able to make a difference. “When we have a goal, everybody’s commitment can be noticed from the leader of the technical team based in Maputo to the most distant health facility.” concludes Dr. Julieta.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 05 Feb 2018 22:47:19 +0000 ridingkm 21 at https://www.vumc.org/friends-in-global-health Collaboration between traditional healers and medical providers at a nearby health center saves lives in Namacurra https://www.vumc.org/friends-in-global-health/success-stories/collaboration-between-traditional-healers-and-medical-providers-nearby-health <span class="field field--name-title field--type-string field--label-hidden">Collaboration between traditional healers and medical providers at a nearby health center saves lives in Namacurra</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 01/05/2018 - 14:13</span> <a href="/friends-in-global-health/blog-post-rss/26" class="feed-icon" title="Subscribe to Collaboration between traditional healers and medical providers at a nearby health center saves lives in Namacurra"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in country) </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Eighteen-year-old Ina Mora was in the district of Gilé visiting her husband’s family when she began feeling ill in May 2017.</p> <blockquote> <p>“Sometimes I had headaches, stomach aches and diarrhea. Both my legs got swollen and I got sick,” recalls Ina.</p> </blockquote> <p>Ina urgently returned to her home in the Namacurra District, Zambézia Province, where she lives with her mother, to seek treatment and support from her family. Her mother took her to a traditional healer, a trusted neighbor who lives in the same neighborhood near the railway station in the district capital. She met with fifty-year-old Florinda Jorge, who has been practicing traditional medicine since 1995.</p> <p>“I saw that this young woman was not well,” said Florinda. “I borrowed a bicycle and carried her to the hospital. There, I found clinicians and told them, ‘I’m bringing a patient.’ I was well received. They gave her the [HIV] test, and it came out positive. From then onwards she has been taking medication, and she is fine.”</p> <p>Today Ina is visibly healthy and has future aspirations of becoming a teacher. Ina’s recovery was made possible thanks to the collaboration between Namacurra District Health authorities and Vanderbilt University Medical Center's Friends in Global Health (FGH), who have been working with traditional healers since 2008. Florinda is one of many traditional healers currently working in collaboration with FGH. She receives on-going training about referring patients showing signs of HIV or tuberculosis to health facilities. FGH provides her with the printed forms traditional healers use to keep track of the patients they refer. It was through her FGH training that Florinda knew Ina’s condition was serious enough to take her to the health facility.</p> <blockquote> <h4>“Here, people prefer going to traditional healers. A large number of patients come from them. The traditional healers are already sensitized. When a traditional healer tries to heal a certain disease and can’t, they will send patients to the health facility,” said Juliana Andrade Talhada, head of Namacurra District epidemiological surveillance activities.</h4> </blockquote> <p>FGH’s support to Namacurra’s health services consists of trainings with peer educators and community leaders on conducting interactive educational talks, called <em>palestras</em>, on a variety of topics including tuberculosis, HIV/AIDS, the referral of pregnant women for antenatal care, and community mobilization. FGH also provides referral and counter-referral forms, on-the-job technical support, and log-books for activities carried out by the traditional healers in the community as well as other resources.</p> <blockquote> <h4>Florinda and Ina are neighbors, and they have a strong friendship beyond that of patient and healer. Florinda continues to check in on Ina’s health, and she confirms Ina regularly takes her medication and goes to her routine appointments at the health facility.</h4> </blockquote> <p>During the last quarter of 2018, traditional healers referred 1,531 people to health facilities in Namacurra District and a total of 6,483 people in all FGH supported districts in Zambézia. The collaboration between traditional healers and health facilities, facilitated by FGH, is positively impacting people’s lives. FGH looks forward to sharing lessons learned in Namacurra to other supported districts in Zambézia, as well as with other clinical implementing partners providing support in other Provinces throughout Mozambique.</p> </div> <div> <strong>Tags</strong> <div> <div><a href="/friends-in-global-health/success-stories?tag=4" hreflang="en">Namacurra</a>, <a href="/friends-in-global-health/success-stories?tag=5" hreflang="en">Traditional Healers</a></div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Fri, 05 Jan 2018 20:13:18 +0000 ridingkm 26 at https://www.vumc.org/friends-in-global-health Male Champions Bring Couples Closer Together https://www.vumc.org/friends-in-global-health/success-stories/male-champions-bring-couples-closer-together <span class="field field--name-title field--type-string field--label-hidden">Male Champions Bring Couples Closer Together </span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 11/02/2017 - 14:19</span> <a href="/friends-in-global-health/blog-post-rss/27" class="feed-icon" title="Subscribe to Male Champions Bring Couples Closer Together "> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>“I was always sick and tired. I could barely do anything,” Laurinda Emiliano tells us during an interview. Laurinda, 19, lives in the Bairro Cimento within the village of Zalala, Quelimane District, Zambézia Province.</p> <p>Starting in 2014, Laurinda mysteriously began to get sick frequently. “I started getting sick and I did not know what I had. Since the illness would not go away, I started visiting traditional healers.” The young woman sought out the cause for her illness for more than three years, but her health was only getting worse.</p> <p>Eventually, one of the traditional healers advised her to go to the clinic. She listened to his advice and went to the Zalala Health Post, where she tested positive for HIV.  She began treatment, but she was not happy with the medical care she received. When a nurse scolded her too harshly for picking up her medication late, she abandoned her treatment program altogether.</p> <p>In June 2017, the Male Engagement Strategy Program was introduced at the Zalala Health Post. The primary purpose of the intervention is to involve male partners of pregnant women enrolled in prenatal care in order to increase the uptake of couples HIV counseling and testing during the pregnancy. The strategy also aims to increase the uptake of ART and improve retention in care among HIV+ pregnant women. Male Champions are trained to work one-on-one with men to teach them how to be supportive of their partners. Men are encouraged to accompany their partners to medical visits and to be tested for HIV themselves.</p> <p>Although Laurinda was not pregnant at the time, she was visited by a Male Champion with the specific purpose of bringing her back into care. </p> <p>Twenty-six year old Arnaldo Felisberto is the Male Champion who, as a trained agent of community change, worked with Laurinda’s husband, Lobito, 20. Arnaldo encouraged Lobito to convince his wife to re-engage in care and to resume ART.</p> <blockquote> <p>“The first time I went to Laurinda’s house she was not feeling well. I tried talking to her and her husband as friends. I knew I would be rejected if I jumped into talking about medication. First, I convinced the husband. The wife no longer cared [about ART]. The husband said ‘no problem. I will convince my wife,’” recalls Arnaldo. He adds, “strategies on how to convince people are taught to us during the [male champion] training.”</p> </blockquote> <p>By using such strategies, the Male Champion was able to convince Laurinda to return to the Health Post. Laurinda was counseled and began taking her HIV treatment (ART) again. Her husband, Lobito, was also convinced to take the HIV test himself. Lobito knew his wife was HIV positive, and supported her return to treatment, but he hadn’t yet taken the test himself. “I never worried about taking the test because I had never become sick,” he confesses.</p> <p>Lobito’s test was positive for HIV and he soon began treatment as well. Four months have now passed and the couple remains adherent to ART.</p> <blockquote> <p>“I’m very strong now. I’m now able to do my work activities without any difficulties. I no longer feel as tired as I used to feel before,” Laurinda tells us happily. She smiles and her face beams with the happiness of someone living a healthy life with HIV. She is also pleased with the support she gets from her husband. “The day before yesterday, due to my farming work, my husband had to get my pills.”</p> </blockquote> <p>According to Erasmo Caminho, the director of Zalala Health Post, without the interventions of the Male Engagement Strategy and Arnaldo, the Male Champion, the couple would not have returned to the Health Post. “Male Champions have helped a lot in this process because they were the ones who convinced Laurinda’s husband to take the test. The fact that he started taking medication has helped his partner not to give up,” emphasizes the Health Post Director. The couple provides encouragement to each other to remain in care and take their ART as prescribed. It is no longer something Laurinda must do on her own.</p> <p><strong>In September 2017, a total of 602 male partners of pregnant women were tested in the ANC compared to 397 male partners in June 2017. </strong></p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 02 Nov 2017 19:19:13 +0000 ridingkm 27 at https://www.vumc.org/friends-in-global-health Key to Adherence: Community https://www.vumc.org/friends-in-global-health/success-stories/key-adherence-community <span class="field field--name-title field--type-string field--label-hidden">Key to Adherence: Community</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 11/01/2017 - 14:32</span> <a href="/friends-in-global-health/blog-post-rss/28" class="feed-icon" title="Subscribe to Key to Adherence: Community"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><strong>The Impact of Community-Based Information, Education and Communication Initiatives and Importance of Community Adherence Support Groups </strong><br /> <br /> Abudo Nicuacua was diagnosed with HIV in 2006. Today, Abudo is an antiretroviral treatment (ART) adherence role model, but this was not always the case. Although he began ART shortly after his diagnosis, he was not convinced that the medications would improve his health. He quickly abandoned care and stopped taking his ART soon after enrollment.</p> <p>Then, in January 2016, Abudo attended a community talk by Friends in Global Health (FGH) trained Male Champion Juma Mantabajabo. The message that stood out to him was that “A person who abandons treatment is putting his life at risk.” Abudo approached the presenter right after the talk with a number of questions. Juma encouraged him “to go back to the health facility to reinitiate ART.” Going through this personal reflection and experience helped transform Abudo into becoming a strong advocate and promoter for ART adherence, as he deeply understood the impact that his words could have on other patients. Since that experience, Abudo has become an FGH-trained Peer Educator.</p> <p>Part of Abudo’s work as a Peer Educator is to encourage the creation of Community Adherence Support Groups (CASGs). CASGs are groups composed of up to six HIV+ people on ART who share the rotating responsibility of medication pick-up. The groups allow members to visit the health facility as little as twice per year, combining medication pick-up for all members with individual medical consultation. Patient retention on ART is negatively affected by long health facility wait times. Many patients also have to travel long distances to health facilities, only to wait for hours in the bright sun or in the rain to pick up their medications. As ART is usually dispensed on a monthly basis, this experience can be very discouraging for patients. CASGs can significantly reduce the amount of time patients need to spend at the health facility, which can help improve retention to treatment. In addition to being the focal point of his own CASG, Abudo encourages the creation of more CASGs in his community as part of his work as a Peer Educator.</p> <p>Another patient, Abdul Ossifo, found that it was not easy to be adherent to ART when he first started taking his treatment in 2014. “The problem was getting to the health facility and the time it took to be seen [by a clinician].” But after meeting Abudo Nicuacua (FGH Peer Educator), Abdul was encouraged to create his own CASG to help alleviate the challenges he was facing picking up his medications. Abdul is now the focal point of a Community Adherence Support Group (CASG) in Pebane District, Zambézia Province. As focal point, Abdul ensures the group meets periodically and maintains communication between his group and their established health facility. </p> <p>Mariamo Jamal is another CASG focal point whose group was established with the help of Abudo Nicuacua. “Being a CASG member changes everything,” he told us. “Today, when one of us goes to the health facility to collect medication, it does not take a long time anymore.”</p> <p>Simão Hélio Benjamim, Pebane District Community Involvement Deputy and Epidemiology Focal Point, praises Abudo Nicuacua’s community work. He recalls that Abudo had abandoned ART, but after receiving “a counselling session, he thoroughly followed the provided guidance. Today, not only is he adherent, as he is also a very active person.” He started encouraging other people to adhere to ART. “When there is a dropout, Abudo does not hold back any effort. He goes searching for any family that has abandoned treatment,” adds Simão.</p> <p>Abudo’s dedication has been changing the lives of people on ART in Pebane. Mariamo Jamal feels that his life changed for the better as a result of the Peer Educator’s dedication. Mariano recalls having “suffered a lot before Abudo guided us to create a CASG.” Abudo encourages the creation of CASGs by delivering health talks at churches, mosques, water pumps, and within the health facility.</p> <p>Abudo also carries out patient contact tracing activities. He is always looking for ways to inform as many people as possible about the importance of taking the HIV test and of adhering to ART. He now volunteers two days per week at the Pebane Sede Health Facility and two days per week in his community. At the health facility, he accompanies HIV patients through the various services and delivers informational talks to patients. In the community, he carries out patient tracing activities and patient home visits with the goal of increasing adherence to treatment.</p> <p>Abudo’s journey from a patient who had abandoned treatment, to being inspired by a community talk, to then delivering talks himself and helping other HIV+ people to establish groups that will prevent them from abandoning treatment shows the positive cascading effect of FGH’s community work.</p> <p>In Pebane District, there are over 2,700 patients on ART who are CASG members, representing 26% of the total number of patients on ART in September 2017.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 01 Nov 2017 19:32:55 +0000 ridingkm 28 at https://www.vumc.org/friends-in-global-health Sangariveira Secondary School: A DREAMS-Friendly School https://www.vumc.org/friends-in-global-health/success-stories/sangariveira-secondary-school-dreams-friendly-school <span class="field field--name-title field--type-string field--label-hidden">Sangariveira Secondary School: A DREAMS-Friendly School</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 10/30/2017 - 14:50</span> <a href="/friends-in-global-health/blog-post-rss/29" class="feed-icon" title="Subscribe to Sangariveira Secondary School: A DREAMS-Friendly School"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Sangariveira Secondary School (SSS) was established in 2012 in Quelimane, Zambézia Province. Currently, the school has 4,980 students, 2,610 male and 2,370 female, who are divided into 42 groups, with morning, afternoon and night student rotations.</p> <p>Located in the outskirts of Quelimane, SSS has a gloomy past. It was infamous for high levels of drug use, early and unwanted pregnancies, prostitution, and illness. </p> <p>In an attempt to change this scenario, the school was selected to become a recipient of <a href="https://www.usaid.gov/what-we-do/global-health/hiv-and-aids/technical-areas/dreams">DREAMS services</a>. The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Initiative focuses on reducing HIV/AIDS in adolescent girls and young women in 10 countries. This initiative also addresses factors that increase HIV vulnerability such as gender-based violence and economic disadvantage. This work is important in order to achieve the Sustainable Development Goal to end AIDS by 2030. Thanks to the DREAMS Initiative, the school has an operational School Health Corner (SHC) with one full-time Maternal and Child Health Nurse (MCHN), one part-time Gynecologist and a part-time Psychologist. The SHC provides the following services: 1) Communication for health, including information, education, and communication (IEC) materials, theater groups, multimedia mobile units, health fairs, TVs and internet access; 2) HIV testing and counseling, primarily conducted through health fairs; 3) Provision of male and female condoms; 4) Family planning; and, 5) Gender Based Violence (GBV) prevention and care. Sixty to seventy students are seen daily at the SHC.</p> <p>This investment is already producing valuable results. Belinha Enoque, SSS point of contact for cross-cutting issues, told us:</p> <blockquote> <p> “According to our school reports, since the establishment of DREAMS, the number of student pregnancies has been reduced 77%, from 30 pregnancies before DREAMS, in the first semester of 2016, to 7 after its establishment in the first semester of 2017.”</p> </blockquote> <p>Another example of DREAMS’ contribution to programmatic change including the provision of education addressing myths about HIV and AIDS transmission is reported by one of the SSS Mentors:</p> <p>“Since the establishment of DREAMS, the demand for HIV prevention talks (palestras) has increased. Thus, apart from group sessions held during week days, we had to introduce HIV awareness sessions on Saturdays. Among others, these talks have helped in reducing myths about HIV and AIDS. Before DREAMS, all (opportunistic) diseases were attributed to a local spiritual disease called “matoua” which allegedly required a traditional healing ceremony called “marombo.” The ceremonies were frequent, at least two or three per week, and  caused school drop outs. Thanks to DREAMS, students do not adhere to these ceremonies anymore, as they are now aware of HIV and AIDS,” – SSS mentor.</p> <p>Paulina Alamo Chombe, the Headmistress of the school, told us of the important impact DREAMs HIV sensitization has had on student awareness of the risks associated with transactional sex:</p> <p>“There is a brothel called Amazonia near the school. Before DREAMS support commenced, whenever I walked out of the school, I used to meet students going to or coming out of the brothel. Although I can’t present figures, nowadays I do not see any ingoing or outgoing movements of my students to that establishment. This is also witnessed by the managers of the brothel that are complaining that the number of SSS students going there has reduced significantly over the last 12 months.”</p> <p>Finally, the DREAMS’ MCHN, Maria Guimarães highlighted the layering (integration/coordination) of interventions between clinical and community partners at SSS:</p> <blockquote> <p> “I think we are the champions of layering. The flow and exchange of beneficiaries between Friends in Global Health-led SHC and local implementing partners’ girl clubs has been successful. The unique identifier card and referral and counter referral guide are fully operational here.”</p> </blockquote> <p>Overall, due to DREAMS success at SSS, and other schools, there is a “domino effect” as other schools are now requesting the establishment of DREAMS activities in their schools.</p> </div> <div> <strong>Tags</strong> <div> <div><a href="/friends-in-global-health/success-stories?tag=7" hreflang="en">DREAMS</a></div> </div> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Mon, 30 Oct 2017 19:50:12 +0000 ridingkm 29 at https://www.vumc.org/friends-in-global-health Health Counselors Improve Patient Satisfaction in Quelimane https://www.vumc.org/friends-in-global-health/success-stories/health-counselors-improve-patient-satisfaction-quelimane <span class="field field--name-title field--type-string field--label-hidden">Health Counselors Improve Patient Satisfaction in Quelimane</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 08/09/2017 - 14:54</span> <a href="/friends-in-global-health/blog-post-rss/30" class="feed-icon" title="Subscribe to Health Counselors Improve Patient Satisfaction in Quelimane"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Farias Fernando Romane recently moved from the Coalane neighborhood to Canecos, within Quelimane District. The move meant that he also changed the health facility where he receives HIV care. When our team met him, it was only his second visit to 24 de Julho Health Center. He was already pleased with the quality of care he has been receiving.</p> <blockquote> <p>“The first day I arrived I noticed that things at this health center work very well. I brought my transfer referral form, and in less than five minutes they called me for a talk, to learn my [health] history and so that they would have all of my information,” Farias told us.</p> </blockquote> <p>After his first counseling session, he was given a date for his next session and antiretroviral (ARV) medication pick-up. He stated that he was very impressed with the quality of care he received during both clinic visits.</p> <blockquote> <p>“As soon as I arrived I was given a ticket and afterwards, [a health counselor] accompanied me to this room for counseling. I see all of this as positive for my health. Those delays of over an hour that used to happen in the past ended up hurting the patients. Many would even give up [on continuing treatment],” Farias told us.</p> </blockquote> <p>The thirty-two year old male is married and is the father of five children. He tells us he is proud to work as a janitor at two local schools, to earn a living and take care of his family.</p> <p>Farias learned that he has HIV approximately nine years ago, but he ignored his status for the first seven. He was not convinced that he needed treatment because he did not feel ill. But as the years passed, his conscience began to weigh on him and in 2015 he decided to take another HIV test. This time he accepted the positive result. Farias ensured that his wife and children were all tested as well. They are all HIV negative.</p> <p>He is now an adherent patient on combination antiretroviral therapy (ART). However, in the past he felt quite frustrated about the reception he received at the health facility.</p> <p>“I used to go to the Coalane Health Center and I saw that [the doctor] was delaying the initiation of my treatment. I started calculating how long ago I was first diagnosed with HIV and I realized many years had passed, and this situation could be bad for me,” he told us. He became concerned about his health and how long it was taking to enroll on ART. He then decided to seek treatment at another health facility. Today, he is content to be on treatment, and is also very pleased with the quality of care he receives at 24 de Julho. He also stated that he has noticed a positive change in the quality of care over the past six months: an increase in the number of counselors available and a decrease in wait time. </p> <p><img alt="Faria e Conselheira 2.jpg" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/global-health/sites/vumc.org.global-health/files/public_files/Faria%20e%20Conselheira%202.jpg" style="width: 400px; height: 267px; margin: 2px;" /></p> <p><span class="text-warning">Teresa Rossumane and Farias Romane at a counseling session at the 24 de Julho Health Center.<br /> Photographer: Cleófas Viagem</span><br /> <br /> Farias’s counseling session was conducted by an FGH counselor Teresa Rossumane, one of 9 new health counselors recently contracted by FGH at the 24 de Julho Health Center, increasing the total number of counselors there to 17. FGH has contracted a total of 124 new health counselors for Quelimane District since January 2017, when FGH first began its support to the capital district. The increase in health counselors is meant to strengthen the provision and quality of health services delivered, specifically in the area of HIV/AIDS.</p> <p>Health counselors are often the first point of contact a patient has at a health facility. As stated by FGH Psychosocial Support Manager Grace Fumane, health counselors play a fundamental role: “Considering that the health counselor is at all testing points, they are key personnel. Their work includes counseling and patient follow-up.” Counselors help patients navigate through both the health process and the building itself, improving patient flow and decreasing wait times. Their primary role is to provide counseling to patients on a wide variety of HIV-related topics such as ARV medication adherence, opportunistic infections, or prevention of mother-to-child transmission (PMTCT).</p> <p>This improved patient satisfaction is the result of the partnership between Friends in Global Health (FGH), the Provincial Health Directorate (DPS) of Zambézia, and the District Health Directorate (DDS) of Quelimane.</p> <p>According to Cristina Impelua, the Director of 24 de Julho, among the various areas of support provided by FGH, the provision of health counselors has significantly contributed to the improvement of health care quality. “Our partnership has just begun, but there are already significant results. One of them is the support we get with regards to human resources, especially health counselors. As a result, patient reception has greatly improved. Above all, with regards to waiting time, patients no longer have to wait for long to be seen.”</p> <p>Teresa explains to us that working in urban Quelimane is a challenge, but one that makes her happy. “For us, counseling people from the city is a bigger challenge. Often times they say they know things. They, however, consistently refuse to follow good health practices. Much patience and dedication is needed. And when we manage to counsel one person to the point that they start improving their behavior, the satisfaction is immense.”</p> <p>After his counseling session, Farias collected his ARV medications and went home. He was content that he didn’t have to spend the entire day at the health center. He promised to return the next month to continue his treatment.</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Wed, 09 Aug 2017 19:54:16 +0000 ridingkm 30 at https://www.vumc.org/friends-in-global-health Participative Theatre Transforms a Life in Namacurra https://www.vumc.org/friends-in-global-health/success-stories/participative-theatre-transforms-life-namacurra <span class="field field--name-title field--type-string field--label-hidden">Participative Theatre Transforms a Life in Namacurra</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 08/04/2017 - 14:33</span> <a href="/friends-in-global-health/blog-post-rss/38" class="feed-icon" title="Subscribe to Participative Theatre Transforms a Life in Namacurra"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Ducha António was first diagnosed with HIV in 2008, during an antenatal consultation. She was just sixteen years old and did not fully understand what HIV was or the impact it could have on her life. She refused treatment for herself, and she was also reluctant to have her infant daughter tested. “I was a teenager with little knowledge of things, so I just ignored treatment.”</p> <p>Ducha’s partner, the father of her daughter, was a married man from Maputo. He returned to Maputo and she never saw him again. She later learned that he had died. “I never knew his health status. So, I did not know it, if he lost his life due to AIDS,” Ducha told us.    </p> <p>It was in 2015 that Ducha happened to see a dramatic performance by Juntos theatre group while attending the health facility in Namacurra Sede with her daughter. Two years later, she still remembers the plot of the play. It had a huge impact on her and in fact changed her life.</p> <blockquote> <p>“They were talking about people that get infected by HIV and learn their HIV status but due to shame refuse treatment. They used the example of a pregnant woman infected with HIV who refused treatment due to fear. As a consequence, she ended up losing her baby. Later, she decided to accept the advice from the health worker, and on her second pregnancy, she took the HIV treatment. She became healthy and had a baby free of HIV.”</p> </blockquote> <p>This story resonated with Ducha deeply and prompted her to reconsider her initial reaction to the HIV diagnosis she had received seven years before. “I went back to my house and started reflecting on what they had talked about. I decided to go to the hospital and started HIV treatment. From then on I have felt very well.” The story about the pregnant woman who lost her baby to HIV made Ducha realize that her daughter was also at risk for HIV. “When I came to my senses, I took my daughter to take the HIV test. Thank God the result was negative. Today she is nine years old and is in the fourth grade.”</p> <p>Juntos is a theatre group active in the district of Namacurra that regularly performs brief dramas addressing a variety of health topics, including HIV. Volunteer actors receive technical support from the Friends in Global Health (FGH) Communications Team. They learn participatory theatre techniques such as creating drama with the right amount of tension to get their audience’s attention, while also learning how to stop the play at opportune times during the performance so they can properly engage those in attendance by having them personalize what is being presented asking them if they have ever experienced similar health issues in their own communities and what should the characters in the performance do next to address these very real issues.  Audience participation is fundamental; when a solution is presented by the community itself there is a greater chance that the community will accept it.</p> <p>Before delivering new plays to the community, Juntos first performs to health workers and Community Involvement Officers from FGH and SDSMAS (District Services for Health, Women and Social Action), who review the plays for accuracy in terms of the health information being delivered. No new plays are performed for the community without at least one review.</p> <blockquote> <p>The theatre group actors are themselves positively affected by their involvement in community mobilization. They personalize the health messages being presented to their own lives and situations, which helps foster further investment in the health of their communities. The Juntos leader, twenty-seven year old Lourenço Marques, told us the following story: “Once we went to perform in the Musseliua-Mause [a small community in the district of Namacurra]. After the presentation, a young man immediately requested to be tested for HIV. That was a touching moment for us. We felt that the result of our work is visible. That motivates us to carry on working.”<br /> <br /> We also talked to José Fernando, the SDSMAS Community Involvement Officer at the Namacurra Health Center about the impact the theatre group is having in his district. “The impact of the theatre group is positive. Behavioral change is happening in the communities where they go, above all in regards to HIV and tuberculosis. We see this in the growing demand for health services. We must continue this type of community mobilization.”</p> </blockquote> <p>FGH currently works with 15 theatre groups, one in each supported district within Zambézia province. In Quarter 3 of COP16, there were 507 theatre performances by FGH supported theatre groups in Zambézia, with 7,658 people in attendance. </p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Fri, 04 Aug 2017 19:33:01 +0000 ridingkm 38 at https://www.vumc.org/friends-in-global-health Dreams Can Come True https://www.vumc.org/friends-in-global-health/success-stories/dreams-can-come-true <span class="field field--name-title field--type-string field--label-hidden">Dreams Can Come True</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/friends-in-global-health/users/ridingkm" typeof="schema:Person" property="schema:name" datatype="">ridingkm</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 05/11/2017 - 17:12</span> <a href="/friends-in-global-health/blog-post-rss/42" class="feed-icon" title="Subscribe to Dreams Can Come True"> RSS: <i class="fa fa-rss-square"></i> </a> <div class="field field--name-field-barista-posts-author field--type-string field--label-hidden field__item">FGH Communications Team (in-country)</div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>By <em>Rui Esmael</em></p> <p><strong>Dreams Can Come True: Over a decade on combination antiretroviral therapy (ART) </strong><strong>with two HIV-uninfected daughters</strong></p> <blockquote>“<em>My biggest dream is to get my children to study and give them a better future.” </em>– Helena Nhanza</blockquote> <p>Helena Nhanza is a 35-year-old mother of two. Specifically, she has two daughters: Elsa, age 8 and Lariza, age 2. The family lives in Chinde, one of the most remote and difficult areas to reach within Zambézia province, Mozambique. To get to Chinde district from Quelimane, the provincial capital, one has to take a combination of motorboats and 4-wheel drive vehicles, which often get stuck in the muddy soil of the Zambezi River Basin. The 350-kilometer sojourn can take up to two days to complete using public transportation. Helena has been living with HIV for more than a decade. Thanks to life-saving combination antiretroviral therapy (ART), which she began in 2007, both of her daughters were born uninfected with HIV. During the 6 years between the delivery of her two daughters, Helena noted a considerable change in the services provided to pregnant women in her community.</p> <p>In 2014, when I was pregnant with my second child, I went back to the antenatal care consultation, but I noticed a difference: after the delivery, instead of sending me to the clinician, there was a dedicated room where everything was done, from counseling to treatment, the laboratory exams and even the pharmacy services,” she stated, enthusiastically.</p> <p>The introduction of the one-stop-model at the Child-at-Risk Clinic (CCR) has considerably improved Prevention of Mother to Child Transmission (PMTCT) efforts. The one-stop-model has meant that women and children can receive multiple health services in a single visit to the health facility, cutting down travel time and cost. Helena considers the new system to be a great relief, as transportation in her district is so challenging. “<em>I felt a great difference between the care provided to me at the birth of my first and my second daughter. The care provided to me with my second child, the one where all services were at a single room, that was very good,” </em>she said. Anifa José, who is responsible for maternal and child health services in Chinde district, emphasized to us the importance of CCR in the fight against HIV.</p> <blockquote>“<em>CCR has come to improve reception, reducing queues at the pharmacy, and making the process more flexible. In the first three months of 2017, as a result of PMTCT and institutional deliveries, Chinde Sede health facility saw the delivery of 8 children free of HIV.”</em></blockquote> <p>Anifa also points out that within CCR services, health counselors play an important role in educating pregnant women about the importance of PMTCT and the benefits of adhering to ART, especially for children. Two health counselors working at the CCR in Chinde Sede, Jaime Maia and Isabel Chiria, were instrumental in helping Helena accept her HIV status, commencing her ART, and believing in the idea that it is possible to have a long, productive life, living with HIV.</p> <blockquote> <p>My biggest dream is to get my children to study and give them a better future. I have been working hard farming my crops and now I am also a volunteer, mobilizing people from my district, just like me, to create an association of people living with HIV. We will prevail together.”</p> </blockquote> <p>Friends in Global Health (FGH) supports CCR services in 110 health facilities in Zambézia province by providing training and mentoring to MCH clinicians and nurses, supporting health counselors and peer educators that work directly with pregnant women and new mothers, as well as assisting with the transportation of medical supplies, laboratory tests and pharmaceutical commodities. FGH frequently rehabilitates rooms at health facilities to create devoted space for CCR services. Between October 2016 and March 2017, FGH assisted 4,093 children in CCR services.</p> <p><img alt="Helena Nhanza" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/SAM_4952rae.jpg" /></p> <p>Helena Nhanza and her two daughters in their back yard.&lt;br /&gt;<br /> Photographer: Cleofas Viagem</p> <p><img alt="Helena Nhanza and her daughter" data-entity-type="" data-entity-uuid="" src="https://www.vumc.org/friends-in-global-health/sites/default/files/images/success-stories/Nhanza_FGH_2017.png" /></p> <p>Helena Nhanza, her daughter, and Anifa José in the Child-at-Risk Clinic.&lt;br /&gt;<br /> Photographer: Cleofas Viagem</p> </div> <div class="field field--name-field-lockdown-auth field--type-string field--label-above"> <div class="field__label">Lockdown Auth</div> <div class="field__item">1</div> </div> Thu, 11 May 2017 22:12:25 +0000 ridingkm 42 at https://www.vumc.org/friends-in-global-health