How a Jhpiego-supported project is linking HIV-positive people to care and treatment in reaching the UNAIDS goal of 90-90-90
Nkhoma, Malawi—About a year ago, Dilore became increasingly concerned about the health of her husband. He would have malaria one week, diarrhea the next—and fall sick again soon after that. “I knew something was wrong,” she recalled. “I even suspected that it could be HIV but I did not have the courage to suggest that we should go for a test.” In April, her husband’s condition deteriorated and a persistent cough landed him in the hospital. Health care providers at Nkhoma Hospital ordered tests for tuberculosis (TB) and HIV. The results were positive for both.
Her husband’s physician suggested that Dilore, a mother of six children, also be checked for HIV. “To be honest, I was a little nervous. But when I entered the testing room, the counselor put me at ease,” says Dilore.
After some discussion, she consented and took the test. It didn’t take long for the results: “I was told that I was also HIV positive.”
Both Dilore and her husband agreed to enroll in the Nkhoma HIV Care and Treatment Center and immediately start antiretroviral therapy (ART), a combination of drugs that suppress the HIV virus and stop the progression of HIV disease. The couple’s infant daughter was also tested and although negative, she was given a medication to prevent bacterial infections that is recommended for all infants born to mothers living with HIV.
Dilore and her family are among the beneficiaries of a successful HIV care and treatment approach underway at Nkhoma Hospital as the government of Malawi rolls out the new Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 treatment strategy. The goals of this strategy are that by 2020, 90% of all people living with HIV know their status, 90% of all people diagnosed with HIV infection receive sustained ART and 90% of all people receiving ART achieve viral suppression. With funding from the U.S. President’s Emergency Plan for AIDS Relief through an expansion of the U.S. Agency for International Development’s Support for Service Delivery Integration (SSDI-Services) Program, the Ministry of Health is working to safely and effectively expand the 90-90-90 strategy and increase coverage of ART by ensuring this package of lifesaving services is optimally implemented and utilized at health facilities and within communities. SSDI-Services, which is led by Jhpiego, received new funding to do this work.
Since the expanded SSDI-Services work began last October, 142,391 people have learned their HIV status through the Jhpiego-supported program. Through this initiative, more than 10,000 people have come to know they have HIV and can start taking the lifesaving drugs they will need to protect their health. Dilore and her husband are among the 9,019 clients who immediately started ART. They represent 85% of those testing positive who are on ART, with their viral load being monitored. That’s a significant achievement for a program still in the early stages.
“My husband and I will have to take these [ART] medications for the rest of our lives while our daughter might stop her medication if her test at two years old comes out negative,” said Dilore, who was eagerly attending educational sessions to learn more about her health and how to better care for her family. Central to SSDI-Services are intensive clinical mentorship and supportive supervision of ART, and services to prevent transmission of HIV from mother to child. The program has introduced and deployed HIV diagnostic assistants (HDAs) and recruited community coordinators and expert clients at facilities such as Nkhoma Hospital, with the goal of safely and effectively expanding the coverage of HIV and TB diagnosis and treatment.
So far, the project has trained 363 clinical officers, nurses, HDAs, counselors and members of the District Health Management Teams in specimen collection for TB and HIV testing services in the districts of Lilongwe, Chikwawa, Salima and Nsanje. The strengthened facility and community providers are also able to check viral load for HIV clients using the dried blood sample technique, interpret data on viral load results, provide intensive adherence counseling and manage clients on ART. In addition, SSDI-Services is also mobilizing Malawians at the grassroots level, participating in community outreach activities and engaging charismatic people living positively with the virus to give testimonies on how they are managing to live healthy lives. The benefits are both immediate and far-reaching. “Although I was not as sick as my husband was, I can tell you that these medications are a life saver,” Dilore said. “Since we both started this treatment back in April, my husband has not been sick. His being healthy is important because our family is big.” “The past six months have been great. We have spent less time on the mat being sick,” she added, smiling.
Both parents need to be available and productive to care for their children, attend their corn farm and grow vegetables for both food and income. Given the hope and energy the program has brought back into their lives, Dilore and her husband do not hesitate to take the 10-kilometer journey to Nkhoma Hospital once a month to refill their medication and check their progress. “We’ve been told that when we reach six months on treatment…a test [will be taken] to see how well we are responding to treatment,” said Dilore. “If the result is ‘undetectable’ it means the medicine is working very well.”