South Sudan

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan

rgoodwin — Wed, 27 Mar 2024 17:44:30 +0000

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan rgoodwin March 27, 2024

April 01, 2024

During World Health Worker Week we’re paying tribute to the wide range of #SafeSupportedHealth Workers who are making a difference in tough situations.

In South Sudan, community outreach volunteers (COVs) like Lawrence Monday play a key role in the HIV response—linking health facilities and communities to extend services and acting as peers to people living with HIV. Under the supervision of an adherence nurse, Lawrence supports 160 clients on HIV treatment, including 15 children.

One of the children Lawrence helps is Timo*, who had a rough start in life. He was born in 2017 into a low-income family in Juba. His biological father was never around to help him as a baby, and his 25-year-old single mother had no job to support him or his two older siblings. She often went to the market to dance with Timo wrapped on her back, and well-wishers would give her some money or food items, which would help feed them for a few days.

Diagnosis and struggle

Timo’s mother knew she was HIV-positive. Although she had been receiving antiretroviral therapy (ART) from Nyakuron Primary Health Care Center (PHCC), when she became pregnant with Timo in 2016, she refused to take treatment and didn’t attend antenatal appointments. She feared she would be stigmatized at the health facility because she knew people who worked there.

When it was time for Timo to be born, his mother had a home delivery without a skilled health care provider. When Timo was three months old, both he and his mother became very ill. He couldn’t breastfeed well, became restless, and started bleeding from the navel. His 60-year-old grandmother rushed him to Nyakuron PHCC where he was assessed and diagnosed with HIV, and immediately enrolled on ART.

With the help of his grandmother, Timo successfully attended treatment for the following year. However, his ailing mother was often intoxicated. She would leave the children with her mother and dash down to a local spree to drink.

Timo’s mother continued to refuse treatment, and in 2022 succumbed to complications of HIV. At the time, Timo and his siblings were already fully under his grandmother’s care and they largely depended on the support of well-wishers.

Home visits from a community outreach volunteer

Nyakuron PHCC is now one of 14 health facilities supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International building local capacity to provide comprehensive HIV services and free ART to people living with HIV in South Sudan. By partnering with the health facilities and local organizations, the South Sudanese government, and communities, AHEC helps train health workers to deliver high-quality HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

In 2021, early on in the project, AHEC trained 160 COVs, including Lawrence Monday. The project provides a stipend and mobile phone airtime for communication to the COVs. In 2013, AHEC attached Lawrence to Timo to monitor his treatment progress through home visits and offer emotional and psychological support.

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says. “I visit all my clients twice every six months, and I visit children at least once a week, because they easily forget to take their medication, to ensure that they adhere to medication. Within the last month, I’ve registered only 5 out of 160 clients with high viral loads, whom I’m closely following up for adherence counseling.”

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says.

Timo was one of those who needed extra follow-up. In February 2023, when Timo was five, he lost weight and became very weak. When health providers at Nyakuron PHCC assessed him, his viral load was too high and unsuppressed. He seemed traumatized by the absence of his mother, lacked enough food, and sometimes refused the bitter taste of the medicine. The health providers developed a monitoring action plan, and after four months of Enhanced Adherence Counseling, his viral load was suppressed. The health provider transitioned Timo from Lopinavir to Dolutegravir and guided his grandmother on how to prepare and give him the medication. Lawrence helped link Timo to a nutrition center within the health facility where he received food portions monthly until his health improved by June 2023.

However, in October 2023, Timo developed swollen lymph nodes and a cough and was losing weight. During a home visit, Lawrence noticed Timo’s symptoms and immediately rushed him to Nyakuron PHCC, where he was referred to Al-Sabah Childrens’ hospital. Health workers at the hospital diagnosed Timo with opportunistic infections, including tuberculosis (TB). Timo was put on anti-TB treatment for six months, which he successfully completed with the help of Lawrence.

Lawrence Monday walks to visit Timo. The Advancing HIV/AIDS Epidemic Control Activity (AHEC) trained 160 COVs like Lawrence to monitor HIV clients' treatment progress. Photo by Achan Gladys for IntraHealth International.

Timo's grandmother brought him to Nyakuron PHCC. It is now one of the facilities supported by the USAID-funded Advancing HIV/AIDS Epidemic Control Activity (AHEC). Photo by Achan Gladys for IntraHealth International.

Going the extra mile

Lawrence visited Timo’s home every two days while he was on anti-TB treatment. He walked two kilometers each way to Timo’s house to ensure he took his medications consistently. “I had to pay more frequent visits to monitor Timo’s treatment progress, especially because he was on both HIV and TB medications. I used to count the tablets to keep track of his medication consistency,” says Lawrence.

Timo is now TB-free and virally suppressed of HIV, following his last viral load test in October 2023. He now looks jolly, is playful, eats well, and weighs an impressive 23kgs. He is one of the 386 children receiving ART from AHEC-supported facilities in South Sudan, as of September 2023. Overall, AHEC currently supports 12,694 active clients on treatment. IntraHealth also linked Timo to Jhpiego, which enrolled him in their USAID Orphans and Vulnerable Children (OVC) program and plans to consider him for academic support in 2024.

“Timo is very healthy now and helps me around with minor chores, which makes me happy. I don’t want him to contract another disease. I’m doing everything it takes to ensure that he eats well and sticks to his medication,” Timo’s grandmother proudly concludes.

*Not his real name.

By Gladys Achan

Communications Officer

Advancing HIV & AIDS Epidemic Control Activity HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Community Health Community Health Workers South Sudan

Is In The Media

Lawrence Monday, a community outreach volunteer (COV), speaks with his young client, Timo, while Timo's grandmother looks on. Photo by Achan Gladys for IntraHealth International.

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In South Sudan, Antiretroviral Therapy Gives Man a Second Chance to Live

cbales — Tue, 01 Aug 2023 13:24:41 +0000

In South Sudan, Antiretroviral Therapy Gives Man a Second Chance to Live cbales August 01, 2023

August 01, 2023

Thanks to his brother and health workers, John is thriving.

Twenty-five-year-old John thinks he may have lived with HIV for over three years before taking a blood test in December 2021. After several failed over-the-counter malaria treatments, John’s older brother Ojok took him to Munuki Primary Health Center in Juba, where he tested HIV positive.

Although health workers immediately enrolled John on antiretroviral therapy (ART), he refused medication and lived in denial for another year.

John’s health deteriorated and in December 2022, Ojok returned him to Munuki Primary Health Center. After health workers at the center performed another positive HIV test, and provided a radiological tuberculosis (TB) diagnosis, he began receiving HIV and TB treatment.

Munuki is one of 14 health centers supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International providing comprehensive HIV services—including Pre-Exposure Prophylaxis (PrEP), an HIV prevention method—and free ART to 11,345 people living with HIV in South Sudan. By partnering with local health facilities and organizations, the South Sudanese government, and local communities, AHEC helps train health workers to provide HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

This time, AHEC attached John to Agnes, one of 161 community outreach volunteers the activity trained to help HIV clients adhere to treatment. Agnes visits John twice a month to assess and understand the challenges he is facing, suggest appropriate recommendations, provide psychological support, and, when needed, accompany him to the health facility for ART refills or counseling.

Galla Moses, a physician and AHEC’s deputy chief of party, examines John during a visit to the orphanage in December 2022. Photo by Gladys Achan for IntraHealth International

During the first visit, John was wasted, weighing just 35.5 kilograms, and had grade 1 oedema. His eyes sunk, his hair was falling out, and he could barely walk without support. AHEC coordinated with ACROSS to assess and enroll John in the nutritional support program at its service point in Munuki health facility. Because John was bedridden and couldn’t access the services by himself, Agnes collected and delivered food portions to him at the orphanage until March 2023, when John was back on his feet and started visiting the health facility.

John lives in an orphanage founded by his brother, which houses 64 orphans, including adolescent girls and young women. IntraHealth collaborated with Jhpiego to assess and screen children at the orphanage for tuberculosis and HIV, whose results all turned out negative, and enrolled 17 adolescent girls and young women in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program. DREAMS, led by Jhpiego in South Sudan, works to reduce HIV infection among adolescent girls and young women through comprehensive HIV services, PrEP, youth-friendly reproductive health care, economic strengthening, post-violence care for survivors of gender-based violence, and psychological support.

Caring community members, health workers, and local organizations are making a difference for people living with, or at risk of, HIV. These partnerships are critical for controlling and ending HIV in the country.

“My brother is my hero,” says John. “He encouraged me to go and get tested for HIV when everyone believed I was bewitched. Now I’m on medication and my life is back to normal. What is more relieving is that I was told at the health facility during adherence counseling that even with my HIV status, I can get married in future and have children who are not HIV positive.”

John poses for a photo with Agnes, his treatment supporter, during a facility visit for ART refill in June 2023. Photo by Achan Gladys for IntraHealth International

Agnes, the AHEC-supported community outreach volunteer, continues visiting John at the orphanage to assess and monitor his health progress and provide coping mechanisms. He now weighs an impressive 50kgs. His viral load is also suppressed and he’s thriving on treatment.

In the 14 AHEC-supported facilities, viral load testing has increased significantly and 87% of HIV clients are virally suppressed.

“I’m grateful to the health workers who have been very supportive and helped me get on treatment,” says John. “Now I sell merchandise at my cousin’s shop. I will use my daily commission to start up my own business soon.”

By Gladys Achan

Communications Officer

HIV & AIDS Health Workers Community Health Workers South Sudan

Is In The Media

John shares a light moment with the ART clinician and his treatment supporter during a medication refill at Munuki Primary Health Care Center in June 2023. Photo by Gladys Achan for IntraHealth International.

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Placement of Dedicated Family Planning Providers to Broaden Method Choice and Increase Contraceptive Access and Uptake: Experience from South Sudan

ihadmin2 — Mon, 27 Mar 2023 19:49:38 +0000

Placement of Dedicated Family Planning Providers to Broaden Method Choice and Increase Contraceptive Access and Uptake: Experience from South Sudan 2023 ihadmin2 March 27, 2023

To improve access to family planning in South Sudan, IntraHealth International implemented a “dedicated provider” model based on evidence that with time, skills, and materials, dedicated providers can serve more women with family planning, meet unmet need, and expand contraceptive choice.

Between October 2019 and December 2020, with funding from USAID under the Evidence to Action for Strengthened Family Planning and Reproductive Health for Women and Girls (E2A) project, IntraHealth recruited and placed nurses and community health workers in nine public-sector health facilities and adjacent communities to address health workforce limitations, expand clients’ method options, increase access to provider-dependent methods, and stimulate further demand to help meet high levels of unmet need for family planning.

This technical brief offers details on the approach and results of this effort.

Download

Countries South Sudan

Projects Evidence to Action (E2A) Project

Topics Family Planning & Reproductive Health Community Health Health workforce development Community Health Workers Nurses

Publisher IntraHealth International

By Eva Canoutas, Patrick Buruga, Lou Eluzai Loponi, Juru Joyce Romano, Anne Kinuthia, Roy Jacobstein

These Adapted Approaches Are Helping Improve HIV Care during COVID-19 in South Sudan

ihadmin2 — Wed, 01 Feb 2023 20:43:50 +0000

These Adapted Approaches Are Helping Improve HIV Care during COVID-19 in South Sudan ihadmin2 February 01, 2023 December 08, 2022

After COVID-19 began to spread, IntraHealth International used two strategies to improve HIV services in South Sudan. The strategies achieved great success and IntraHealth is transitioned them to South Sudan’s Ministry of Health for implementation across the country.

In collaboration with the US Centers for Disease Control and Prevention (CDC) and the International Centre for AIDS Care and Treatment Program (ICAP), IntraHealth used the Incident Management System and Granular Site Management strategies, which fostered teamwork and built data analysis and problem-solving skills among health workers.

By late 2020, COVID-19 had already affected both access to and the quality of health services. And in South Sudan, it was no different. IntraHealth’s Strengthening National Capacity for Integrated HIV/AIDS Health Data Collection, Use, and Dissemination in Support of an Evidence-based Response team saw that the number of adults and children with HIV who were receiving antiretroviral therapy was down to 56%, but because of COVID-19 restrictions, the team wasn’t able to conduct site improvement or joint supportive supervision, and inadequate coordination made implementation with partners at health facilities difficult.

In response to these challenges, CDC, IntraHealth, and ICAP partnered to roll out two different approaches across IntraHealth-supported health facilities: the Incident Management System (IMS) and the Granular Site Management (GSM) strategy.

“The GSM initiative has had many positive impacts on the health facility.”

IMS was originally developed to coordinate and manage responses to World Health Organization-designated public health emergencies of international concern. But Nigeria decided to adopt the IMS approach to manage their HIV programs and saw improved outcomes at high-volume facilities. So South Sudan followed suit to grow their HIV program.

GSM is an intensive approach for onsite program data review and quality improvement that helps improve health workers’ performance, grow HIV programs, and improve the quality of HIV services. Field officers work with teams of health workers to collect data daily. Then they submit data every week to project staff who generate dashboards that are used to review performance and create improvement plans.

After a core team of CDC, IntraHealth, and ICAP members formed in early 2021, they created a three-tiered structure to improve collaboration, streamline communication, and implement IMS:

The organizational unit (CDC, IntraHealth, and ICAP)
Three regional levels led by teams from IntraHealth, ICAP, and RTI International
Facility-level granular site management teams led by field officers.

After the GSM strategy underwent pilot testing, the team rolled it out across 28 high-priority facilities. IntraHealth provided six Zoom accounts to support the GSM calls across the selected sites, developed the schedule, and trained facility staff to use the continuous quality improvement (CQI) methodology to analyze data from the weekly dashboard and implement interventions.

Embedding the CQI approach within the GSM rollout helped 25 field officers and 45 facility staff build their knowledge and skills to provide improved HIV services. It also increased health workers’ confidence because they were participating in calls together with the Ministry of Health, PEPFAR, implementing partners, and other health facility staff.

“The introduction of the GSM initiative to the HIV/AIDS and TB program has had many positive impacts on the facility,” says Tabu Richard Lokeri, a clinician at the Saint Theresa Mission Hospital-Isohe. “Our facility team members are now able to generate and analyze facility data to make informed decisions at the facility levels and we are able to make significant improvements in HIV case identification through index testing.”

The GSM approach allowed space for everyone to attend the same meeting to discuss issues affecting program growth, which led to quick decision-making, easier acceptability of the interventions proposed in the meeting, and close follow-up. Unlike when data is used only at the national level, the GSM approach allowed facility staff to analyze and interpret weekly dashboards and make decisions based on evidence.

The GSM approach allowed facility staff to make decisions based on evidence.

“Through GSM we were able to raise performance issues affecting the facility,” says Olori Thomas, an antiretroviral therapy clinician and the Nyong Primary Health Care Center. “As a result, our facility is now renovated, which has created more space for maintaining clients’ privacy and confidentiality. We were also able to learn and understand our facility gaps and mutually agree on interventions to address them. Through GSM, there has always been room for discussion and learning how different facilities in the region have achieved their targets.''

The GSM methodology has fostered teamwork and built data analysis and problem-solving skills among project teams. Because of its success, the IMS is now transitioning to the Ministry of Health to scale up and introduce to all facilities across the country.

Merekaje Grace and Wole Moses contributed to this news item.

South Sudan HIV & AIDS COVID-19 Strengthening National Capacity for Integrated HIV/AIDS Health Data Collection, Use, and Dissemination in Support of an Evidence-based Response in South Sudan

Couples Who Get Tested for HIV Stay Informed—Together

ihadmin2 — Fri, 13 Jan 2023 19:07:09 +0000

Couples Who Get Tested for HIV Stay Informed—Together ihadmin2 January 13, 2023

December 05, 2022

How trained health workers are helping to improve HIV services in South Sudan.

Ladu, a 33-year-old resident of Juba, South Sudan, was hesitant to get tested for HIV. His mother had encouraged him and his fiancé to get tested, but he was wary of a possible HIV-positive test result.

In July 2022, he visited the Kimu Primary Health Care Center to learn more about voluntary HIV counseling and testing. After talking to the health worker at the facility, he felt reassured. He decided to visit the facility with his fiancé the following day to test for HIV.

A trained health worker made all the difference.

The Kimu Primary Health Care Center in Juba is supported by IntraHealth International’s Advancing HIV/AIDS Epidemic Control (AHEC) Activity. AHEC provides HIV services in South Sudan to help ensure HIV viral suppression and reduce AIDS-related deaths and further transmission of the virus. By partnering with local organizations, the South Sudanese government, and local communities, AHEC helps train health workers to provide HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

For Ladu and his fiancé, a trained health worker made all the difference.

“At first, I feared that I might test HIV-positive and that my girlfriend would refuse to marry me,” he says. “But the health worker explained everything to us. They also said that knowing our HIV status would help us live healthier lives, so we decided to get tested.”

The couple were impressed by how fast the process was. When they received their results, they were both negative.

More couples are choosing HIV testing and counseling and are practicing safe sex.

Since AHEC began in November 2020, it’s been scaling up comprehensive HIV services in South Sudan’s Central, Western, Eastern Equatoria, Jonglei, Lakes, and Western Bahar-el-Gazhal states. More couples are now choosing voluntary HIV testing and counseling and are practicing safe sex, which means fewer cases of HIV. So far, more than 55,000 clients have tested positive for HIV and over 4,600 clients have been enrolled in care and treatment in the last two years.

Because Ladu and his fiancé intend to get married, they also wanted to learn more about safe sex practices until they both decide they are ready to have children. Ladu’s mother encouraged the couple to use condoms until the end of the three-month window for possible HIV infection, but neither of them knew how to use them. So during their visit to the Kimu Primary Health Care Center, the health worker used male and female models to provide a demonstration.

“We both hadn’t had sex before and didn’t know how to use a condom,” says Ladu. “But the demonstration was helpful."

The health worker also taught them about the availability of other family planning methods and gave them male and female condoms to prevent sexually transmitted infections (STIs) and unwanted pregnancy.

“In my culture, condom use is highly prohibited due to lack of knowledge that exposes many young people to STIs, including HIV,” says Ladu. “But now that we have learned how to use a condom, we hope to start practicing safe sex until we both test HIV-negative again after three months. I appreciate IntraHealth for bringing free HIV services to our community. I’m encouraging all young people who intend to marry to visit a health facility and test for HIV before engaging in sexual intercourse.”

AHEC is funded by the US Agency for International Development.

By Gladys Achan

Communications Officer

Advancing HIV & AIDS Epidemic Control Activity HIV & AIDS World AIDS Day Health Workers South Sudan

Photos

A health worker provides HIV pretest counseling and teaches the couple how to use male and female condoms at the Kimu Primary Health Care Center in Juba. Photo by Gladys Achan for IntraHealth International.

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South Sudan's Health Workforce Is Better Equipped than Ever, Thanks to Investments in Strategic Information

ihadmin2 — Fri, 13 Jan 2023 15:06:34 +0000

South Sudan's Health Workforce Is Better Equipped than Ever, Thanks to Investments in Strategic Information ihadmin2 January 13, 2023 November 03, 2022 Juba, South Sudan

For ten years, IntraHealth International’s Strengthening National Capacity for Integrated HIV/AIDS Health Data Collection, Use, and Dissemination in Support of Evidence Based Response project in South Sudan has helped transform the Ministry of Health’s data, policies, surveillance, reporting, and strategic plans. The results: a better-equipped health workforce and stronger health systems for South Sudan.

IntraHealth has been working in South Sudan since 2006 and began to focus on strategic information in 2012 with the Strengthening Systems, Capacity & Data Collection with a Focus on Strategic Information in South Sudan project. Together, the two strategic information projects:

Implemented a District Health Information System 2 (DHIS2) reporting system
Developed and updated national policies, guidelines, and strategic plans
Helped the Ministry of Health conduct surveys and surveillance and create a research and ethics review board
Strengthened monitoring and evaluation services in health facilities through field supervision
Founded the South Sudan Public Health Institute (SSPHI)
Designed and deployed a COVID-19 vaccination tracker and certificate.

The teams achieved these results for the country’s health system in the wake of conflict, insecurity, climate disasters, and numerous disease outbreaks, including the global COVID-19 pandemic. Adding to these challenges were South Sudan’s health workforce shortage of trained, skilled health workers. So IntraHealth began working with the Ministry of Health to gather and review data to inform their decision-making using DHIS2, a web-based open-source platform for data management and analysis.

Now, health officials can access data in real time.

“Data about health services in South Sudan were being sent by email at the county and state levels and were then transmitted via Excel spreadsheet,” says Alfred Okiria, the project director. “Now, health officials can access data in real time using DHIS2, which allows them to capture more data in a streamlined way.”

Over a two-year period (2020 – 2022) overall reporting improved from 43% to 77%. Reporting at PEPFAR-supported sites was at 100% by 2022. As reporting increased, the project team (with Ministry of Health and PEPFAR staff) continuously monitored data quality and trained 78 focal persons to conduct surveillance at 78 project sites.

IntraHealth trained over 1,300 data clerks along with 268 monitoring and evaluation officers and 650 health workers in 80 counties. Additionally, 25 field officers were trained during an eight-week program and seconded to 86 facility sites where they mentored and trained 1,540 health workers and helped community volunteers track clients who had been lost to care and bring them back.

“We used the granular site management (GSM) system—an intensive onsite program data review—and quality-improvement approaches to improve health workers’ performance, grow the HIV program, and improve the quality of HIV services,” Okiria says. “The field officers worked with their teams at the facility level, collected data daily and submitted them on a weekly basis to our staff who generated the weekly dashboard, reviewed performances and discussed them at GSM meetings, and created improvement plans.”

When COVID-19 began to spread, IntraHealth supported the setup of the incident management system and designed and deployed a DHIS2 COVID-19 tracker and vaccination tracker to support the COVID-19 data management. The project designed a verifiable digital COVID-19 vaccination certificate that over 3,500 clients used for travel across borders.

Turnaround time for reviews dropped from three-to-six months to three weeks.

At the institutional level, the team also worked with the Ministry of Health to overhaul the research and ethics review board. They established a secretariat, supported the hiring of a research director, and created an income-generating model. Turnaround time for reviews dropped from three-to-six months to three weeks.

The project also established a new public health institute and completed its strategic plan and monitoring and evaluation framework.

“It’s a key pillar for disease outbreak prevention, detection, and response,” Okiria says. “This is a historic project for the country and it’s something we will be part of for many years. It will help shape the future of global health in South Sudan.”

In June 2022, the South Sudan Public Health Institute graduated 42 people from the institute’s data management and leadership, management, and governance programs. It also supported the training of 99 field epidemiologists on the Field Epidemiology Training Program and 20 health workers on the incident management system.

South Sudan’s health workers are now more equipped than ever to provide high-quality services for their communities. That includes a much stronger data-collection and reporting system, diverse capacity-building programs such as fellowships and field supervision, intensive engagement with communities to increase use of health services, and collaboration and investment in program integration at all levels of the health system.

South Sudan HIV & AIDS COVID-19 Digital Health Health workforce development Global health security Health Workforce & Systems Management and Performance Health Workers Strengthening Systems, Capacity & Data Collection with a Focus on Strategic Information in South Sudan

A New Partnership Strengthens HIV Services in South Sudan

ihadmin2 — Thu, 12 Jan 2023 15:00:18 +0000

A New Partnership Strengthens HIV Services in South Sudan ihadmin2 January 12, 2023

September 26, 2022

And provides more opportunities for this local organization to thrive.

While it’s only been a little over a year since their partnership began, the Community Initiative for Development Organization (CIDO) and IntraHealth International have already seen improvements in both access to and quality of HIV services in South Sudan.

The HIV prevalence rate among adults in South Sudan ages 15 to 49 is 2.1%. Only about 27% of people living with HIV in the country know their status and are on treatment. The South Sudan government is working to eradicate HIV, but instability due to violence and insecurity have led to a weakened health system. People often struggle to access the health services they need, especially since COVID-19 began to spread in 2020.

So IntraHealth International's Advancing HIV/AIDS Epidemic Control Activity (AHEC) is working with the government to build health workers' skills and strengthen existing health systems in the country. To do this, they partner with local organizations like CIDO, a women-led nonprofit organization that has been implementing development and humanitarian assistance programs in South Sudan since 2016.

In August 2021, CIDO partnered with AHEC’s Grants Under Contract (GUC) program, which provides technical assistance and support services to four local organizations to help them increase access to community-based HIV/AIDS services in Juba and Tambura counties and learn how to directly manage future PEPFAR funding.

“When CIDO started partnering with IntraHealth, the support was enormous,” says CIDO’s AHEC project officer, Leru Michael.

“With consistent mentorship and technical assistance from AHEC guiding us through each program implementation, our performance has improved progressively, especially through refresher trainings that renew our knowledge on comprehensive HIV service provision.”

Our partnership approach

The partnership has already helped CIDO achieve important project milestones and improve their results. Over the past year, AHEC:

Trained CIDO staff on the South Sudan Ministry of Health's new HIV self-testing protocols as an additional method for HIV testing, helping to kickstart their community activities
Facilitated training and on-the-job mentorship sessions to help CIDO develop HIV program capacity, including data visualization and management, presentation tools, and monitoring and evaluation skills.
Conducted biweekly performance review meetings for 46 community outreach volunteers and consistently reviews CIDO’s performance to provide insight for better performance.
Helped CIDO identify clients who have been lost to follow-up and trace clients who use community HIV services.
Provided technical training for community outreach volunteers and focal persons for viral load, early adherence, and indexing to create greater demand for HIV testing services and manage care and treatment.
Provided donor referrals to help CIDO secure diverse funding opportunities.

CIDO now ensures all forms of HIV services are available to clients when they visit a facility to refill their medicine (which reduces a client’s transportation costs) and sets weekly targets to ensure they reach every client.

"I didn’t know how to use data presentation tools, but IntraHealth taught me and I’m now an expert.”

“IntraHealth staff mentor and give us weekly support and guidance before implementing any activity,” says Iya Tobi, CIDO’s monitoring and evaluation officer. “When I joined the project, I didn’t know how to use data presentation tools, but IntraHealth taught me and I’m now an expert.”

A CIDO sign outlining their vision, mission, and core values. Photo by CIDO for IntraHealth International.

AHEC and CIDO team members during a visit to CIDO's office to discuss capacity building and technical assistance. Photo by CIDO for IntraHealth International.

Between July 2021 and June 2022, CIDO provided HIV testing services to 5,256 clients, all of whom received their test results. Of those tested, 591 were HIV-positive and successfully started antiretroviral therapy (ART) in AHEC-supported facilities. CIDO also increased access to community-based viral load sample collection services for 1,002 ART clients and identified and returned 383 clients to care who had lapsed on ART treatment.

Many of these milestones are due to community outreach volunteers—people living with HIV who understand their social network and go to different communities to spread information about the importance of knowing one’s HIV status. They mobilize members of their communities to get tested and receive counseling through referral networks.

“Community outreach volunteers are like our eyes,” Leru says. “We encourage them to establish a good relationship with clients so that more people come to test for HIV. We also focus on our targets by identifying several clients for each community outreach volunteer subgroup and meet weekly to assess our progress. If case targets are not met, we discuss how to achieve our goals.”

This support has created a data-driven culture at CIDO, one that focuses on monitoring and evaluation and consistent data documentation in CIDO-supported facilities. CIDO’s new decentralized project structure has also improved team unity, human resources management practices and systems, communication, and relationships with facilities and the AHEC team. Because of this, AHEC now provides targeted mentorship sessions to improve staff competencies.

Working with CIDO to strengthen and expand their HIV services is helping to create a solid foundation for community HIV programs, now and in the future. Despite the many challenges organizations in South Sudan face, with AHEC’s support, CIDO is flourishing and building capacity to take on more projects and partnerships like this.

By Gladys Achan

Communications Officer

By Patrick Zema Alivile

Capacity Building Manager

HIV & AIDS Management and Performance Quality of Care South Sudan

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Is In The Media

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Patrick Zema Alivile

ihadmin2 — Thu, 12 Jan 2023 14:57:35 +0000

Patrick Zema Alivile Capacity Building Manager ihadmin2 January 12, 2023

Patrick is the capacity building manager for IntraHealth's Advancing HIV/AIDS Epidemic Control Activity (AHEC).

South Sudan

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Grace Merekaje

ihadmin2 — Thu, 12 Jan 2023 14:27:41 +0000

Grace Merekaje HIV/TB Field Coordinator ihadmin2 January 12, 2023

Grace is an HIV/TB field coordinator in South Sudan. She has a Master of Science degree in public health from the University of Leeds and a Bachelor of Science degree in biomedical technology from the University of Nairobi.

South Sudan

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Community Outreach Volunteers Help Clients Navigate HIV Prevention, Care, and Treatment in South Sudan

kseaton — Fri, 29 Jul 2022 16:03:32 +0000

Community Outreach Volunteers Help Clients Navigate HIV Prevention, Care, and Treatment in South Sudan kseaton July 29, 2022

August 02, 2022

How tracing changes health outcomes in Juba.

Rose,* a 54-year-old widow and mother of five in Juba, South Sudan, is HIV-positive. She started antiretroviral therapy (ART) as soon as she was diagnosed with HIV in 2018 but did not disclose her status to her children right away—she knew her family might be at risk of contracting HIV and recognized that her children should be tested, but she felt a lot of self-stigma, which held her back from talking about it with them.

Rose was also part of a religious community that preached against modern medicine and after listening to healing testimonies from others, she was convinced that she could be healed of HIV through prayer. She stopped taking ART for over two years and her health deteriorated. She lost weight and suffered from other infections related to HIV.

Luckily, Rose met Sarah,* a community outreach volunteer working with IntraHealth International’s Advancing HIV/AIDS Epidemic Control (AHEC) Activity, a USAID-funded project. Sarah is also HIV-positive and, as a community health worker, she conducts outreach in her community. She shares her experiences with her clients and encourages them to test and know their HIV status, to adhere to ART treatment, and to visit health facilities regularly for viral load sample collection to attain viral load suppression.

Sarah's support encouraged me to adhere to my treatment.

Sarah met Rose while doing community outreach and Rose became one of Sarah’s clients. Sarah provided her with psychological support, such as providing ways Rose can focus on her health and well-being, and adherence monitoring, making sure Rose maintains her medication regimen to achieve viral load suppression. She also talked to Rose about the importance of disclosure and how to live positively without passing on the infection to others.

“The community outreach volunteer assigned to me was an evidence-based example that even with HIV, one can live a long healthy life while on ART,” Rose says. “Her support encouraged me to adhere to my treatment.”

Sarah talked to Rose about restarting her HIV medication and the importance of disclosing her status to her family. Rose was hesitant at first, but eventually took her children to the Munuki Primary Health Care Center, an AHEC supported health facility. While at the facility, all five of her children tested HIV negative. The ART provider at the facility counseled Rose on the importance of adherence to care and treatment, and she was reinstated on ART.

Rose is now a community outreach volunteer champion who visits clients in her community and helps refill ART prescriptions for those who are unable to visit their health facilities. She shares her knowledge and experiences with other HIV-positive members of her community and encourages clients to continue with their treatment.

The AHEC project has given us a second chance to live.

“Community outreach has helped us reach many people, including men, who have then been diagnosed with HIV and linked to ART,” Rose says. “I’m very happy because IntraHealth, through the AHEC project, has given us a second chance to live. We’re looking forward to the start of PrEP intervention in the country that will protect those at high risk of HIV from acquiring new HIV infections.”

There are currently 8,825 clients on care and treatment in all AHEC-supported facilities. Through community outreach volunteer tracing efforts, 932 clients (66% of those who stopped treatment between October 2021 and May 2022) have returned to the health facility as of May 2022.

AHEC is funded by the US Agency for International Development.

*Not her real name.

By Gladys Achan

Communications Officer

Advancing HIV & AIDS Epidemic Control Activity HIV & AIDS Community Health Community Health Workers South Sudan

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