Central America

How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS?

cbales — Fri, 01 Dec 2023 14:08:44 +0000

How Is Our USAID Project in Central America Partnering with Communities and Community Health Workers to End AIDS? cbales December 01, 2023

December 01, 2023

Communities are at the forefront of progress in the HIV response.

The UNAIDS theme for World AIDS Day this year is Let Communities Lead. A new report highlights that communities living with, at risk of, or affected by HIV are at the forefront of progress in the HIV response, including connecting people to HIV services, and calls for more action to enable and support communities in their leadership roles.

We sat down with Yadira Villaseñor, IntraHealth’s Central America regional director and the head of one of our largest HIV programs, to find out how her team is collaborating with communities, community organizations, and community health workers (CHWs) to reach more clients with HIV services.

Villaseñor is the chief of party for the five-year USAID HIV Care and Treatment Project in El Salvador, Guatemala, Honduras, and Panama. According to 2022 data via UNAIDS, 103,000 people in these four countries are living with HIV and 31% are not on antiretroviral therapy (ART). The project focuses on training and equipping health workers to deliver high-quality HIV care and treatment, reducing stigma toward key populations (KPs) and people living with or at risk for HIV, and improving adherence to ART.

Q: How is the USAID-funded HIV Care & Treatment Project partnering with communities in Central America to increase access to stigma-free HIV services and help more people living with HIV receive treatment?

In Central America, the HIV epidemic is concentrated among KPs—men who have sex with men, transgender women, and sex workers. Stigma and discrimination, limited access to health care (including HIV prevention initiatives), and migration make the region vulnerable to a growing HIV epidemic. Our project provides technical and financial support to local community organizations that work with these KPs. This year we have sub agreements with five local NGOs, and we meet with them weekly.

Through the community organizations, we identify KP peers in these communities to be trained as CHWs and link them to facilities and implement community outreach activities.

For example, our previous USAID project in the region introduced health workers called adherence promoters to provide HIV counseling and testing and treatment support in health facilities. Adherence promoters immediately link people who are HIV positive to treatment, encourage HIV clients to attend routine medical appointments, identify clients at risk of dropping out of ART, link clients to other health or social services, including for treatment of opportunistic infections and co-infections, and follow up with people who don’t show up for their appointments. They work closely with community liaisons, who conduct home visits to clients who drop out of treatment.

Community liaisons coordinate with other community testing partners to improve linkage rates for referrals, so recently diagnosed users can be greeted and accompanied by them to clinical services. Community liaisons also provide direct service delivery such as counseling in the home, bringing ART medications when they can´t be picked up, providing emotional support when needed, helping patients recover when they have interrupted their treatment, and service reminders via WhatsApp. They deliver services in a culturally respectful manner that’s language appropriate and tailored to the users’ needs.

Wilfredo Esquivel is an adherence promoter working in Hospital de Puerto Barrios, Izabal, Guatemala. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel (third from left), an adherence promoter, is a key part of the team of health workers at Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel meets with an HIV patient, Nancy Bermudez, in Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

HIV client Nancy Bermudez is then attended by Doctor Hector L. Romero at Hospital de Puerto Barrios, Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel also goes out into communities to provide HIV services. Here he boards a boat from Puerto Barrios to Livingston Izabal to conduct home visits. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel travels from from Puerto Barrios to Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel locates the home of HIV clients in Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel delivers groceries and provides counseling to clients in Livingston Izabal, a small village in Guatemala only reachable by boat. Photo by Levi Dieguez for IntraHealth International.

Wilfredo Esquivel visits another HIV client outside her home in Livingston Izabal. Photo by Levi Dieguez for IntraHealth International.

Q: How does the project invest in and support these community health workers?

There are now 41 adherence promoters and 46 community liaisons across the four countries. The project pays these CHWs and provides other support.

We provide training and technical assistance to develop and strengthen CHW competencies. To do this, we analyze available evidence-based information and summarize it in culturally sensitive and appropriate print and audio/visual materials that are easy for CHWs to use.

We invest in digital health tools and capacity for CHWs. For example, during COVID-19 shutdowns and other emergencies like hurricanes, we supported community liaisons to use surveillance tools and alerTAR, a mobile phone tool that sends text reminders, to identify and reach HIV clients who missed HIV appointments and connect them to services at facilities and carry out home treatment.

We support CHWs’ mental and physical health. For example, when we saw the toll the COVID pandemic was taking on them, we offered them mental health support to help reduce and manage their work-related stress. We also ensured all health workers had information about and access to COVID-19 vaccines, which helped them safely vaccinate other people in their communities and address vaccine hesitancy.

Q: How does the project advocate for local governments to invest in CHWs as part of their HIV response?

While recognition of the importance of CHWs has grown, challenges persist related to formal recognition, compensation, training, and integration into the formal health care system. Addressing these challenges and further strengthening the role of CHWs is essential for increasing access to HIV services. We are working with local and national policymakers to formalize the role of CHWs at the community and facility level.

We encourage local health authorities to analyze their context and identify key actors—including local NGOs and community members and health workers—to implement the health agenda. At the same time we work with national government officials, in coordination with ministries of health and social security institutes (a parallel system in Central America for health services for workers) to obtain their endorsement of community health workers to be linked to HIV clinics under their authority.

In addition, we document and share results obtained through CHW efforts with key decision-makers. For example, during the first year of our project, we documented and shared that community liaisons reengaged 1,841 (39%) HIV patients lost to follow-up, and adherence promoters provided counseling and 83% of their clients reached viral load suppression. I’m proud to now share that as of September 2023, our project and health workers we support provide HIV services to 43,104 people living with HIV and 95% have achieved viral load suppression.

Q: What advice do you have for how other implementers and development programs should partner with and invest in local communities and community health workers?

IntraHealth, as well as many other international NGOs, is moving to a locally led development strategy. This will allow us to expand our mentorship and facilitating role with many community-based organizations who provide the CHWs that are much needed to improve access to services. I think other implementers and development programs should:

Advocate with authorities at central and local levels to gain political support for CHWs and accept them as key local actors in the development of their communities.
Highlight the contribution of CHWs through fact sheets, success stories, and “situation rooms.” Situation rooms are regular meetings at sites, like HIV clinics, where data is analyzed by a diverse team with an eye on improving performance, utilization of HIV services, and access to HIV services and treatment as part of a comprehensive package. In other words, use data and tell the story of impact in a personal way.
Listen to CHWs and understand their needs.
Invest in training CHWs and strengthening their capacities. Provide in-person coaching to empower them and ensure that they develop and maintain the desired skills.
Sensitize health workers and personnel at the facility level to accept a range of support services from CHWs to reach the most marginalized and vulnerable communities, and recognize that community outreach interventions are key to reaching the United Nations 95-95-95 goals.
Materially and financially support the development of their work.

It is not always easy to do this through a project-based cycle, though we have demonstrated some great successes through our projects. In the future, we need more programmatic approaches for other actors, funders, donors, the private sector, and impact investors to form partnerships with community organizations and communities to hire CHWs between the larger projects that come and go.

Yadira Villaseñor spoke about partnering with communities during a Clinton Global Initiative event at the UN General Assembly. Click on the link and register to watch the event, then navigate to the session titled "Innovations in Access: How to Expand Our Health Care Workforce Through Diverse Community Stakeholders."

By Carol Bales

Strategic communications manager

By Jenny Alcázar

Communications Specialist

By Yadira Villaseñor

Chief of party, Central America HIV Care and Treatment Project and regional director, Central America

HIV & AIDS Community Health Health workforce development World AIDS Day Community Health Workers

Is In The Media

Yadira Villaseñor (right), chief of party for the USAID HIV Care and Treatment Project, stands with health workers outside of Hospital de Puerto Barrios in Izabal, Guatemala. The project works with teams of health workers, including community health workers identified by community organizations we partner with, to deliver high-quality HIV services to more people in Central America. Photo by Levi Dieguez for IntraHealth International.

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In Central America, Health Workers Keep HIV Services Available despite Dual Disasters

kseaton — Tue, 01 Dec 2020 19:04:59 +0000

In Central America, Health Workers Keep HIV Services Available despite Dual Disasters kseaton December 01, 2020

December 01, 2020

Health workers battle a pandemic and two hurricanes to get HIV treatment to clients in Central America.

The COVID-19 pandemic has created plenty of barriers for people living with HIV who need to continue their care and treatment. But when hurricanes Eta and Iota hit Central America in November, the barriers multiplied.

Pounding Nicaragua, Honduras, El Salvador, Panama, and Guatemala for days, these two hurricanes brought heavy rains that led to flooding and landslides that devastated communities and affected millions.

In the face of these dual crises, health workers in Central America demonstrated strong leadership and commitment to their clients, using person-centered strategies to continue providing HIV/AIDS services. They knew they needed to maintain direct contact with their clients. They also knew this would be difficult, as the storms forced many to leave their homes.

When HIV clients move, the services must follow

While work, discrimination, and long distances to health services are usually the reasons people travel to neighboring countries for health care, COVID-19 and the two hurricanes have also influenced many Central Americans’ movements and forced many health facilities to close. Many HIV clients could no longer go to their usual places for care.

"Our objective during COVID-19 is to keep working."

So IntraHealth International's HIV Care and Treatment Project (HCTP) adapted its existing alert system alerTAR, to help find clients on the move and connect them to services no matter where they were. alerTAR is a rapid text messaging system that sends reminders to clients to take their medications, notifies them about upcoming clinic appointments, and generates immediate alerts to health personnel so they respond rapidly to clients who miss appointments or are at risk of stopping antiretroviral therapy (ART). It’s currently used in 34 HIV clinics in Central America.

When hurricanes Eta and Iota uprooted even more HIV-positive clients, IntraHealth used alerTAR to send 900 messages to clients who needed information. In Izabal, Guatemala, for example, they said "If you lost your medicine or have an appointment, come to the clinic or call this number.”

And using alerTAR and SUMEVE—the national HIV monitoring, evaluation, and epidemiological surveillance system in El Salvador—health workers from IntraHealth’s HCTP identified two Guatemalan clients and one Honduran client who normally access HIV services in El Salvador but couldn’t because of COVID-19. The three had shared their information through alerTAR, which helped them connect with health systems in other countries.

Adherence promoters, Beatriz Duque, from the Sonsonate National Hospital in El Salvador, and Pamela Molineros, from the Luis Ángel García Family Clinic of the San Juan de Dios National Hospital in Guatemala, conducted this type of coordination so that their clients could receive counseling and medication where they were.

"As a promoter, I feel satisfied having facilitated the delivery of medicine to a Salvadoran patient who was in Guatemala,” Beatriz says. “Because borders closed, she could not collect her medicine here, but was able to do so in Guatemala."

Juan*, used to get his clinic checkups at the Zacamil National Hospital in El Salvador, where he lived. But when the pandemic spread, he returned home to his native Honduras. Because he had consented to receiving messages through alerTAR, his contact information was on file and he could be linked with the Mario Catarino Hospital there.

"Our objective during this COVID-19 emergency is to keep working,” says Siro Argueta, the project’s country representative in El Salvador, "so that all patients with HIV continue to adhere to their treatment.

December 1 is World AIDS Day and this year we are celebrating the ingenuity and perseverance of health workers during COVID-19 through the PEPFAR theme: Ending the HIV/AIDS Epidemic Through Resilience and Impact.

IntraHealth International’s HIV Care and Treatment Project in El Salvador, Honduras, Panama, and Guatemala, is funded by USAID. It focuses on reaching clients with high-quality, stigma-free services and works together to enroll and retain as many people living with HIV as possible on treatment.

*Names changed to respect confidentiality.

By Claudia Guzmán

Graphic Design and Communications, HIV Care and Treatment Project

USAID HIV Care and Treatment Project HIV & AIDS COVID-19 Digital Health World AIDS Day El Salvador Guatemala Honduras Panama

Photo by Trevor Snapp in El Salvador for IntraHealth International.

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What’s the Future of HIV Care in Central America, During and After the Pandemic?

cbishopp — Wed, 01 Jul 2020 17:48:07 +0000

What’s the Future of HIV Care in Central America, During and After the Pandemic? cbishopp July 01, 2020

July 01, 2020

People living with HIV must be able to continue with their treatment, despite COVID-19.

In Central America, closures and shutdowns related to COVID-19 have left many people—including those who live with HIV—unsure about where to pick up medications or how to get the health services they need.

Yadira Villaseñor leads IntraHealth International’s work in Central America. She sat down with us to talk about how the region and its frontline health workers are tackling the pandemic and what the future of HIV care in Central America might look like.

How are you responding to COVID-19 in the region?

Here in Central America, we are adapting as much as we can during this challenging situation. Because frontline health workers face greater risk of COVID-19 infection, we are training them on how to respond to the disease, especially in how it relates to HIV treatment and prevention.

We are also providing HIV treatment outside of the health facilities we support and dispensing medications that will last clients for multiple months, so they don’t have to go pick up their antiretroviral treatment (ART) at the pharmacy as often.

And we are working with ministries of health to adapt and be flexible during this situation. People living with HIV must be able to continue with their treatment, despite the pandemic.

How are you seeing people who live with HIV affected by the pandemic? Do you think it could threaten HIV progress in Central America?

COVID-19 is certainly affecting HIV progress in Central America.

We work in five Central American countries and one of the most permanent priorities in all of them during this pandemic is to sustain the gains we’ve already made toward HIV epidemic control and to support ART delivery.

Our work promotes health equity, gender equity, and human rights.

The government has restricted transportation and social distancing is necessary, which has led to challenges in delivering medical care. We are trying to minimize patient contact with health facilities and limit it to essential needs while ensuring that people who live with HIV get the best possible outcomes.

We track clients’ needs and have developed methods for being in contact with them, but I think access to ART will be interrupted. We know that some people living with HIV will not access the treatment they need because they cannot go to the facilities. So we are focusing on delivering treatment to clients outside of the facilities.

Also read: mHealth Tool Is Keeping Central American Clients Connected to HIV Care amid COVID-19 Shutdowns

IntraHealth has been helping communities in Central America since 1993. What about this work most excites you?

We offer people who live with HIV the promise to be healthy and increase their viral suppression.

Our work promotes health equity, gender equity, and human rights. People who live with HIV face a lot of stigma and discrimination, but if they are adhering to treatment, they reduce their viral load and become healthier people—this helps many to recover their self-esteem. It’s important to me for people who live with HIV to have what they need to lead healthy lives.

And we’re also creating new models and approaches to adapt to the constant changes in the region. Each country we work in has different challenges, so we anticipate the different situations and risks, and we build trust with all stakeholders. We are always thinking strategically and with our mission in mind. That makes me proud.

As we all grapple with COVID-19, how important is universal health coverage?

Universal health coverage should be based on strong, people-centered primary health care.

Right now, during the pandemic, a lot of attention is given to the hospitals. But if we focus on primary health coverage, people could receive all their services—including services that prevent COVID-19 or other infections—in their communities.

But we also need to focus on quality of health care, which is a challenge here in Central America. At IntraHealth, we support health workers to perform their best. We must continue working at all levels of care, but focus our efforts on primary health care and strengthen it.

What will the future look like for HIV care and treatment in Central America?

The future of health care in Central America starts with strong alliances with all stakeholders.

The strain of the COVID-19 pandemic will make it very challenging to achieve the 95-95-95 goals. But these challenges will become opportunities for us to be more creative and to propose new models to achieve our goals.

I am so proud to be part of IntraHealth because I think this is an organization that really cares for people. Not just the health workers, but the clients and all staff. We are part of a very great team here.

IntraHealth’s work in Central America is funded by the US Agency for International Development.

By Katherine Seaton

Former communications manager

By Yadira Villaseñor

Chief of party, Central America HIV Care and Treatment Project and regional director, Central America

HIV & AIDS COVID-19 IntraHealth's 40th AnniversaryUnaFgYhifdw

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AIDS 2020 Virtual

cbishopp — Thu, 14 May 2020 13:23:25 +0000

AIDS 2020 Virtual cbishopp May 14, 2020

July 06, 2020 - July 10, 2020

The International AIDS Conference is the largest global health gathering in the world. It is the premier conference for those working in the field of HIV, as well as for policy-makers, persons living with HIV, and others who are committed to ending the pandemic through science, advocacy, and policy.

In light of COVID-19, the conference will be held virtually this year. IntraHealth International's delegation will present research on retention, reaching key and priority populations with PrEP, voluntary medical male circumcision, and more.

Presentations are available on demand. View the program here.

Resilience

UNAIDS

ICASO

International Community of Women Living with HIV/AIDS

https://www.aids2020.org/registration/

Our Participation

Poster Presentation

Achieving PEPFAR’s funding level for local organizations: Challenges and successes to getting to 70% in Ethiopia

Date(s):	July 06, 2020 08:00am EDT
Location:	Poster Channel - Track E
Presenter(s):	Catherine Brokenshire-Scott

Reengaging patients lost to follow-up through community liaisons in unsecure low-burden settings: Experience from El Salvador

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track C
Presenter(s):	Ricardo Mendizabal-Burastero

High HIV and syphilis prevalence among female sex workers at the border of South Sudan and Uganda

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track C
Presenter(s):	Alfred Okiria

Simplifying the ShangRing technique for voluntary medical male circumcision among priority adolescent and adult men: Results from an acceptability and safety study in Tanzania

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track C
Presenter(s):	Kija Nyalali

Mobile technology and human-centered design to reach adult men with voluntary medical male circumcision service: There’s an App for that

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track E
Presenter(s):	Peter Dotto Lubambi

Behavior Design Methodology for Uptake of Voluntary Medical Male Circumcision among Fisherfolks in the Lake Zone of Tanzania

Date(s):	July 06, 2020 09:00am EDT
Location:	Abstract Sessions On-Demand Channel
Presenter(s):	Zaynab Lweno

Patient-identified reasons for poor early retention in HIV treatment amidst a “surge strategy” to increase linkage to care: Insights from Eastern Uganda

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track E
Presenter(s):	Irene Mirembe

Location, Location, Location: Increasing uptake of HIV services among key and priority populations in slum settings: Experiences from Tororo District, Uganda

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track C
Presenter(s):	Godfrey Muzaaya

Improving retention of HIV clients at 12 months: Successes of community-based differentiated service delivery models in Bukwo District, Uganda

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track E
Presenter(s):	Sam Cherop

Improving retention in HIV care through routine monitoring and back-to-care campaigns: Lessons from Eastern Uganda

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track E
Presenter(s):	Yusuf Namanya

Reaching key and priority populations with PrEP: Lessons from Eastern Uganda

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track E
Presenter(s):	Carol Karutu

Peer-led HIV self-testing successfully reaches key populations in rural Eastern Uganda

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track E
Presenter(s):	Carol Karutu

Three HIV incidence estimation methods reveal high incidence among female sex workers in Juba and Nimule, South Sudan

Date(s):	July 06, 2020 09:00am EDT
Location:	Poster Channel - Track C
Presenter(s):	Alfred Okiria

Delegates

Catherine Brokenshire-Scott

Project director, Accelerating Support to Advanced Local Partners

Sam Cherop

Cluster technical manager, Uganda RHITES-E project

Carol Karutu

Chief of party, Uganda RHITES-E project

Peter Dotto Lubambi

Monitoring and evaluation manager, Tanzania ToharaPlus project

Zaynab Lweno

Capacity building and mentorship advisor, Tanzania ToharaPlus project

Ricardo Mendizabal-Burastero

HIV/AIDS senior advisor, Central America

Irene Mirembe

Knowledge management manager, Uganda RHITES-E project

Godfrey Muzaaya

HIV team lead/VMMC manager, Uganda RHITES-E project

Yusuf Namanya

Community linkages & referral technical advisor, Uganda RHITES-E project

Kija Nyalali

Director of monitoring and evaluation, Tanzania ToharaPlus project

Alfred Okiria

Project director, CDC South Sudan project

Kate Stratten

HIV program director

Sujata Bijou

Senior measurement and learning technical advisor

Andrew Durkin

Program officer, East Africa

South Sudan Tanzania Uganda El Salvador HIV & AIDS International AIDS Conference

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Virtual

United States

We’re Moving Fast to Help Health Workers Worldwide Combat COVID-19

kseaton — Thu, 26 Mar 2020 19:43:30 +0000

We’re Moving Fast to Help Health Workers Worldwide Combat COVID-19 kseaton March 26, 2020

March 26, 2020

A message from IntraHealth’s new president and CEO, Polly Dunford.

Today, as COVID-19 continues to invade our thoughts and lives, my mind is on frontline health workers.

They don’t have the option to work from home, as many of us are doing today. They’re on the front lines as I write this—in hospitals, clinics, and triage centers around the world—putting themselves at risk to stop this pandemic. Now, more than ever, health workers need our support.

Last week, as I began my new job as president & CEO at IntraHealth International, I saw that our country and global teams had mobilized immediately to adapt our programs in the communities we serve to respond to COVID-19:

In Rwanda, our team is redirecting the systems and procedures we helped establish to prevent an Ebola outbreak—including a national call center, isolation units, and training for health workers on surveillance, screening, case management, and infection prevention—toward the country’s national COVID-19 response.
In Mali, we’re helping the country prepare through a well-coordinated One Health multisectoral approach. Already our team is reinforcing frontline health workers with new standard operating procedures, updated guidelines, and tools adapted specifically for COVID-19.
In Liberia, the Ministry of Health is using mHero—a two-way communication platform that we and our partners developed during the 2014 Ebola outbreak in West Africa—as a surveillance and response platform for a range of diseases, such as Lassa fever, measles, and cholera. They’re also using it to send COVID-19 messages to health workers as part of the country’s response to the pandemic.
In Central America, frontline health workers are using our COVID-19-adapted, mobile phone-based alerTAR system to let HIV clients know when, where, and how they can keep getting their antiretroviral medicines, now that public transit and many outpatient services in the region have closed.
In South Sudan, our team is collaborating with the US Centers for Disease Control and Prevention to look at the epidemic curves in affected countries, mortality trends, and the population pyramid of South Sudan to provide the government with scenario models and recommendations as it prepares for COVID-19 to strike its population.

Right now, I take comfort in knowing that all of you—all of us—share the same objective IntraHealth has had for 40 years: to give health workers the tools, equipment, and support they need. That is how we’ll get through this pandemic and keep our communities safe for the long haul.

Now is the time to apply all we’ve learned through biomedical research, data, and on-the-ground expertise and experience, and to leverage and increase our investments in health workers and the systems in which they work. Together, we can flatten the curve and save lives.

By Polly Dunford

Former president and chief executive officer

COVID-19 Digital Health Health Workers Liberia Mali Rwanda South Sudan

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Resumen Regional Centroamérica

cbishopp — Mon, 06 Jan 2020 15:03:10 +0000

Resumen Regional Centroamérica 2021 cbishopp January 06, 2020 Download

Countries El Salvador Guatemala Honduras Nicaragua Panama

Dora García

cbishopp — Thu, 21 Nov 2019 18:58:10 +0000

Dora García Guatemala Field Coordinator, HIV Care and Treatment Project cbishopp November 21, 2019

Claudia Guzmán

cbishopp — Thu, 21 Nov 2019 18:57:07 +0000

Claudia Guzmán Graphic Design and Communications, HIV Care and Treatment Project cbishopp November 21, 2019

In One Guatemalan Hospital, Peer Support Groups Boost Quality of Life for People Living with HIV

cbishopp — Thu, 21 Nov 2019 18:46:54 +0000

In One Guatemalan Hospital, Peer Support Groups Boost Quality of Life for People Living with HIV cbishopp November 21, 2019

November 21, 2019

Groups meet each month to learn from each other’s experiences and encourage one another to strive for better lives.

For people living with HIV in Malacatán, Guatemala, adhering to the required treatment regimen isn't always easy. The area’s economy is highly mobile due to its proximity to the Mexican border, and HIV is stigmatized, making it difficult to be open about one’s status and access care.

But at one area hospital, a new peer support group for patients initiating or restarting treatment makes committing to better health a collaborative process.

Since February 2019, a group of patients have been meeting each month to learn from each other’s experiences managing the virus and to encourage one another to strive for a better quality of life. The group is made up of individuals at risk of not following their treatment regimens, having high viral loads, or just starting treatment. Surrounded by a support system including other people living with HIV, as well as an adherence promoter, nutritionist, and other members of the project’s multidisciplinary team, patients hold each other accountable and build self-esteem. And when a group member misses a meeting, the others follow up and encourage their return.

"We have emerged from depression."

“In each session we attend, we feel confident to talk about the problems we have because we are sharing with people who have the same problems as us,” said one couple. “We have emerged from depression.”

Peer support groups are part of a person-centered strategy implemented by IntraHealth International through its USAID-funded HIV Care and Treatment Project. This strategy aims to help people living with HIV adopt a healthy lifestyle and stick to their treatment regimen in order to reduce their viral load and boost their quality of life.

Monthly face time with other patients as well as project and clinical staff builds trust and encourages people to take advantage of all the resources available to them.

"It’s not just seeing the doctor and picking up your treatment,” says nutritionist Marixa Orozco. "Patients interact with the staff in charge of each area. And then they are willing to see the psychologist or the social worker, because they already know who they are and feel comfortable.”

By the end of August, which marked six months of antiretroviral treatment (ART), patients underwent CD4 count and viral load testing. These are routine procedures that measure how many CD4 cells, a type of white blood cell, and amount of HIV are in the blood and provide important information to health workers about patients’ immune systems, the virus’ progression in their bodies, and how they and the virus are responding to ART.

And the results were impressive: 90% of patients had fewer than 1,000 copies of the HIV virus, indicating that the virus was not progressing and that their treatment plans were effectively controlling it.

An individual with untreated HIV would have a low CD4 count and a high viral load. With these results, patients were seen as “stable” and thus able to shift to collecting medicine every two months, meaning fewer disruptions to their work schedules and less money spent on transportation to and from the clinic.

The bond of a shared experience directly impacts the health outcomes of group members, who include patients living with comorbidities like tuberculosis.

“I feel privileged receiving attention in the clinic and for the support that the whole team has given us,” one group member says. “I want to continue being part of the peer support group so that the sadness is forgotten and I am able to live longer."

By Dora García

Guatemala Field Coordinator, HIV Care and Treatment Project

By Claudia Guzmán

Graphic Design and Communications, HIV Care and Treatment Project

USAID HIV Care and Treatment Project HIV & AIDS Guatemala

Photo by Anna Watts for IntraHealth International.

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Community Liaisons Are Resourceful and Persistent

intrahealth — Thu, 05 Apr 2018 20:34:11 +0000

Community Liaisons Are Resourceful and Persistent intrahealth April 05, 2018

April 06, 2018

This week, we’re featuring stories from frontline health workers all over the world. It’s just one of the ways we’re celebrating World Health Worker Week 2018.

Imagine having to travel for hours to a faraway health facility to get regular, critical care—even though there’s a similar facility just down the road from your home.

This is what Luis*, 49, struggles with in Western Guatemala. He wants to get the HIV care he needs, earn a living, and maintain his privacy all at the same time—but it’s difficult.

“In [the closest] HIV clinic, there is a cleaning lady who lives a couple of blocks from my home,” he says. “If she sees me, the whole village will know I am living with HIV.”

Clients like Luis fear social retribution, and worry that they won’t be offered work if their HIV-positive status is found out. Luis opts not to seek care in the nearest hospital for this very reason. And due to employment reasons, he’s had to drop out of HIV treatment several times in the seven years since he was diagnosed.

In Central America, where IntraHealth International leads the USAID | Central America Capacity (CAMPLUS) Project in El Salvador, Guatemala, Honduras, and Panama, social stigma is one reason why clients abandon their treatment plans. For some, the financial burden of traveling to a faraway health facility is too great—but so is the risk of running into someone they know closer to home. It’s a double bind.

Community Liaisons

According to UNAIDS, 112,000 people are living with HIV in these four countries. During October 2016 to September 2017, 25% of people living with HIV were not adhering to their antiretroviral therapy (ART), based on viral load results at HIV clinics.

To increase this number, health workers called community liaisons are tracking down clients who have dropped out of treatment.

The work is challenging. Community liaisons must search for vulnerable clients in isolated, hard-to-find places, while balancing discretion with a commitment to care. Once they find the clients, the liaisons can offer instruction on how to adhere to ART regimens and discuss ways to overcome the practical and personal obstacles clients face.

Pascacio Colop is a liaison in Quetzaltenango, Guatemala. He knows the importance of protecting patients’ privacy and earning their confidence to get them back to treatment.

“We must gain the patients’ trust,” he says. “Oftentimes clients drop out HIV treatment for fear of stigma and discrimination. Because of this, I introduce myself to them as a friend, not as a hospital employee.”

Poor adherence to treatment puts patients at risk of transmitting HIV to others, virus mutation, and secondary infection. By keeping their viral load at undetectable levels through a strict treatment regimen, they give the virus less of a chance to develop resistance—and themselves a greater chance of living a long and healthy life.

By conducting home visits, community liaisons represent a caring and respectful arm of the health care system. It’s this personal touch that ultimately compels many clients to recommit to ART.

“Having someone take the time to come to their home and say that they are concerned about their health and their lives is what finally drives a patient to resume treatment and become adherent,” Pascacio says.

An Advocate for Access

Community liaisons are resourceful and persistent. They advocate for people living with HIV and work with support organizations within the hospital to provide resources for client transportation, or even help deliver patients in need to the health facility.

Rodrigo,* 34, and his partner Gisela,* 33, were able to call upon their community liaison, Victor Arriaga, when Gisela’s health deteriorated after dropping out of treatment.

“We did not know who to call,” Rodrigo says. “The ambulances charge for fuel. So we called Don Victor. Thanks to him, she is alive.”

Community liaisons provide information in a culturally sensitive, thoughtful way.

“I have had some cases of patients reporting they are taking a medicinal plant, or saying the church pastor told them God cured them,” Pascacio says. “In those cases, we explain, with respect for their beliefs, how the virus works in their bodies and what they need to do to be well.”

According to Dr. Ana Gómez, Coordinator of the HIV Clinic of the National Hospital of the West, Quetzaltenango, "the search for treatment dropouts is a key intervention conducted with the support of the USAID | Capacity Project. We have recovered people who we considered lost. This approach is very valuable, since it combines institutional efforts with community action.”

982 People Back on Treatment

Finding people isn’t always easy, and liaisons have learned that it’s most effective to begin searching as early as possible when clients stop coming for treatment. As more time goes by, it becomes increasingly difficult to recover them.

From October 2016 to September 2017, 29 community liaisons in El Salvador, Guatemala, Honduras, and Panama set out to find 5,658 people marked in facility records as having dropped out of HIV treatment. Many of those people had died. In fact, the liaisons confirmed 2,510 deaths. And while 2,166 remain unfound, mostly due to a lack of contact information in the records, the liaisons recovered 982 dropouts through home visits.

The difference for those 982 individuals was the compassion shown to them by dedicated community liaisons.

Maria Jose, a liaison in dangerous gang-controlled areas of El Salvador, says that people feel valued when they get a visit from her.

“‘Seriously, you are concerned about me? You came to see me?’ patients always ask,” she says. “And this makes me proud to be a part of their recovery—that with these small actions, I can improve their quality of life.”

*Names have been changed.

The UNAIDS 90-90-90 goals stipulate that by 2020, 90% of people living with HIV will know their status, 90% of people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. Adherence is vital to achieving these goals.

Renato Hernandez contributed reporting for this story.

By Casey Bishopp

Former communications officer, IntraHealth International

Central America CapacityPlus Project HIV & AIDS Community Health World Health Worker Week

Pascacio Colop is a community liaison in Quetzaltenango, Guatemala. He knows the importance of protecting patients’ privacy and earning their confidence to get them back to treatment. Photo by Anna Watts for IntraHealth International.

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