Chorinde, Angola—A song rose through the rural Angolan health center, but the upbeat tune wasn’t a top-40 radio hit or a traditional African anthem. It was nurse-trainer Helena Cumbelembe Inacio leading a group of health workers in a melody about a lifesaving HIV medication protocol: preferred regimen—TDF, 3TC, efavirenz combined; alternative regimen: AZT, 3TC, efavirenz combined.
Helena adapted a popular French nursery rhyme to the elements of the preferred HIV medication regimen as a clever memorization trick to help the nurses at the Chorinde Health Center who were struggling to recall the correct combination of medicines to prevent pregnant women who have HIV from passing the infection to their children.
Angola’s Institute for the Fight against AIDS had taken the bold step of accelerating a plan to expand Option B+. This approach, recommended by the World Health Organization, offers all pregnant and breastfeeding women who are HIV positive a combination regimen of three antiretroviral (ARV) drugs immediately upon diagnosis that they would continue to take for life. The goal is to preserve the health of HIV-positive mothers and prevent onward transmission of the virus that causes AIDS.
Jhpiego, in coordination with the Angola Ministry of Health, has been working through the Strengthening Angolan Systems of Health (SASH) project to build the capacity of nurses to provide malaria treatment, family planning services, HIV testing and counseling, and, now, lifelong antiretroviral therapy (ART). SASH, known as ForçaSaúde in Portuguese, is funded by the President’s Emergency Plan for AIDS Relief through the United States Agency for International Development and is implemented with the partner Management Sciences for Health.
For the nurses at this rural facility—a four-hour ride from the central Angolan city of Huambo—remembering the three-medication ART protocol was proving to be a challenge. They had the essential skills to care for patients, but they lacked recent refresher training and struggled in this new area of HIV treatment.
- Nurse-trainer Helena Cumbelembe Inacio with colleagues whom she helped train on a new drug protocol for HIV treatment.
“The learning was slow, and they [the nurses she was training] could not pronounce well the names of the ARV drugs, let alone remember the combination of the drugs,” recalls Helena. “What should I do?” she asked herself.
The 42-year-old nurse-trainer answered her own question: “I said, well maybe through a song they will learn the names and the combination.” So, Helena and her fellow trainer Dinis Cardoso changed the lyrics of “Frère Jacques” to follow the three-drug treatment regimen. In Portuguese, the first verse lyrics were:
Esquema prefrencial: Te-De-Efe, Te-De-Efe, Tres t- ce, Tres t- ce, Efavirense, Efavirense, mistura, mistura.
“It was quick and easy,” Helena remembers. “The nurses sang and danced, the names stuck and they could remember the combination very well. Even when we went back for supervision, they recited the ARVs correctly.”
Helena and Dinis’s clever job aid was a small step toward increasing access to lifesaving ART for pregnant women, helping ensure that nurses throughout the country were properly trained to deliver ART. The nurses’ struggle illustrates the reality of health services in rural Angola. During years of civil war, many of the country’s well-educated nurses emigrated to cities, leaving rural health centers like Chorinde with a deficit of skilled health care workers. The remaining nurses are dedicated, but often lack continuing professional education.
Through the SASH project, Jhpiego has trained more than 650 nurses in rural health centers in new skills that will better serve the needs of Angolan women and families. The benefit of training these nurses in administering lifelong ART can be seen in the number of HIV-positive pregnant women who received ART in 2014. For example, of the 524 pregnant women diagnosed with HIV in Huambo Province, 343, or 66 percent received ART, an increase from only 13 percent in 2013.
That’s the kind of outcome that is saving lives and giving the next generation of Angolans a healthy start in life.
So sing with the nurses: Esquema prefrencial: Te-De-Efe, Te-De-Efe, Tres t- ce, Tres t- ce, Efavirense, Efavirense, mistura, mistura.