Mozambique has one of the highest rates of HIV infection — about 13% — in sub-Saharan Africa. With the expansion of health care delivery services provided by Vanderbilt’s Friends in Global Health (VUMC/FGH), patients in Quelimane District, the capital of Zambézia Province, now account for more than 30% of the total number of patients receiving care through the Avante Zambézia program. Multidisciplinary teams of clinical and support staff provide assistance to health facilities in the District.
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.
“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.
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 & evaluation officers, counselors and volunteers. They all work together to create a strong network of support for the district health authority.
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.
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.
“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.”
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.
These facts do not go by unnoticed by the Quelimane District health authorities:
“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.
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).
“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.
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.