Guatemala

Jenny Alcázar

kseaton — Tue, 18 Jan 2022 19:44:21 +0000

Jenny Alcázar Communications Specialist kseaton January 18, 2022

Jenny is a communications specialist for the HIV Care and Treatment Project in Central America.

Guatemala

Spanish

English

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Mental Health Services Help Health Workers Improve HIV Services in Central America

kseaton — Tue, 18 Jan 2022 19:04:52 +0000

Mental Health Services Help Health Workers Improve HIV Services in Central America kseaton January 18, 2022

January 19, 2022

Health workers on the front lines of this pandemic get the help they need for stress, exhaustion, anxiety, and burnout.

"During the pandemic, there have been a lot of stressful moments,” says Juan,* a health worker who helps clients return to treatment after missing their previous appointments. “And those were in addition to continuing to reach the goals of our HIV program.”

It’s no secret that COVID-19 affects mental health and well-being for us all—but especially for health workers. Lack of knowledge about the disease, the spread of misinformation, and fear of contracting COVID-19 have taken a toll on our emotional and physical wellbeing.

Health workers on the front lines of this pandemic experience stress, exhaustion, anxiety, and burnout. At the same time, they’re getting less emotional support, sleep, family time, and time off. They suffer, and so do the health services they provide.

We had to take care of ourselves in the health center.

IntraHealth’s HIV Care and Treatment Project (HCTP) team knew that if health workers on our staff were suffering, so would their clients. So

IntraHealth offered 39 health workers in three countries mental health support through therapeutic sessions with a licensed therapist via phone or video calls to help reduce and manage their work-related stress.

“We had to take care of ourselves in the health center, as we were being exposed to clients at the clinic and others who regularly attend outpatient clinics,” Juan says. “IntraHealth provided us with psychological support to help us personally strengthen our attitudes to face this new reality we were living in.”

HCTP also helped health workers get vaccinated, advocated for vaccinations in the community, readjusted health worker workloads, instituted a flexible work policy to support health workers with family responsibilities, and helped them manage stigma, violence, or fear from family, friends, and their communities.

To do all this, the project began by screening health workers in Guatemala, El Salvador, and Honduras. The team then provided therapy to each health worker according to the level of need they expressed in their screening. Across each country, employees who expressed a low need received two sessions of therapy, those with medium need received four sessions, and those with high need received seven sessions. At each session, health workers discussed a variety of topics with the therapists, including how to manage:

Stress
Rejection by family, friends and/or the community after being exposed to COVID-19
Symptoms related to stress, anxiety, and/or depression
Regulating their emotions
Negative feelings
Self-care
Fears, feelings of helplessness, vulnerability, and loss of initiative.

Through their sessions, they acquired strategies and tools to manage physical symptoms and improve poor sleep and hygiene patterns, increase their physical care, and adequately manage the work stress they experienced.

And the sessions made a difference.

After the therapy sessions were complete, the project team noticed improvements in the physical, social, emotional, work, and family aspects of the health workers’ lives. The strong emotions many had experienced—such as frustration, anger, sadness, confusion, discouragement, isolation, loneliness, insecurity, and fear—also decreased.

“These sessions allowed us to not just see pure work, but sometimes also the moments to be listened to, moments to smile, to remember that it was not the time to look down on others, but on the contrary, to welcome them,” Juan says. “We had to get closer to people.”

Through these mental health services, the health workers learned to balance different areas of their lives and adapt to their new reality. They acquired strategies to assertively manage the stigma they experienced. Their symptoms of anxiety and depression decreased.

This was also helped by the COVID-19 vaccine. After IntraHealth advocated to the Ministry of Health to provide vaccines for its health workers, over 86% of the HCTP health workers were vaccinated as of September 2021, which helps them physically and mentally as they vaccinate other people in their communities.

We’ve seen first-hand that psychoeducation for health workers helps improve their physical and mental self-care at both a personal and professional level while reducing anxiety and depressive symptoms.

Now, health workers across three countries in Central America have the tools they need to be both physically and mentally healthy and can provide the right services for their clients when they need them. And we have the knowledge and tools to scale up mental health services in the region and around the world because investing in the mental health of health workers is an investment in the well-being of the communities they serve.

*Name has been changed to respect anonymity.

The HIV Care and Treatment Project is funded by the US Agency for International Development.

By Jenny Alcázar

Communications Specialist

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

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3 Ways Health Workers in Central America Are Delivering HIV Care during a Pandemic

kseaton — Fri, 11 Dec 2020 16:35:05 +0000

3 Ways Health Workers in Central America Are Delivering HIV Care during a Pandemic kseaton December 11, 2020

December 14, 2020

We’re adapting our health services to reach clients in new ways.

In Central America, the COVID-19 pandemic has created new barriers for people living with HIV to adhere to their antiretroviral therapy (ART) regimen. People living with HIV face lack of transportation, reduced clinic hours and sites, and fear of going to clinics—all of which make it harder for them to continue taking their medication.

So health workers from Nicaragua, El Salvador, Guatemala, Honduras, and Panama are using some new approaches to help their clients overcome these obstacles.

alerTAR in El Salvador, Guatemala, Honduras, and Panama

As part of the COVID-19 emergency response, many hospitals in Central America have reduced business hours, restricted access to outpatient consultation clinics and, in some cases—like at the Tela Hospital in Honduras—transferred HIV services to different clinics.

For clinic coordinator Dr. Nerlyn Gutierrez and his team, this was cause for concern. The health workers knew they needed to contact clients about the service location change, but had no way to communicate with them, which would make it hard for clients to obtain their medication or receive much-needed services.

So IntraHealth’s HIV Care and Treatment Project (HCTP) turned to the mobile phone platform alerTAR for a solution. The alerTAR system is a low-cost, CommCare-based tool that helps health workers at 26 ART clinics in El Salvador, Guatemala, Honduras, and Panama send treatment reminders via SMS to thousands of clients who may be cut off from their usual health facilities. Tela Hospital implemented the alerTAR system in 2019 to strengthen retention and prevent clients from abandoning their ART.

Using AlerTAR, José Gutiérrez, the data entry officer for HCTP, sent 394 clients text messages with important information about the new clinic location and daily reminders about appointments and medication intake. Thanks to the helpful messages, HCTP provided care to 389 people in the new clinic.

“Sending messages through alerTAR is an excellent way to keep patients motivated and show them that many people care about their health,” Gutiérrez says. “Patients who received the messages were very happy and grateful, since it’s difficult for them to attend their medical appointments due to mobility restrictions, economic limitations, and lack of public transport.”

alerTar training in Guatemala. Photo taken by Mario Fernando Hernández for IntraHealth International.

Enhanced adherence counseling in Nicaragua

At the onset of the COVID-19 pandemic, fear of the virus became a barrier for some clients. Many stopped attending integral care clinics despite the facilities' protective measures, such as all staff using face masks, increased hand-washing, use of hand sanitizer, and physical distancing. Because of this, 149 of the HIV Care and Treatment Project clients were ready to abandon their treatment instead of visiting HIV clinics.

But we didn’t want to let that happen. With our partner organization in Nicaragua, the Nicaraguan Association of Positive People (ANICP + VIDA), we connected clients with their treatment.

ANICP + VIDA employs enhanced adherence counseling and helps people living with HIV recognize the importance of their treatment, identify barriers to adherence, and learn strategies to overcome them so they can achieve and maintain viral suppression. When they learned that almost 150 people were thinking about abandoning their HIV treatment, ANICP + VIDA pivoted—and processed patient authorizations to obtain the medicines their clients needed and deliver it to their homes. They organized a team, created geographic service routes, and leveraged transportation methods to provide an immediate and effective response.

The new approach worked. Between March and August 2020, ANICP + VIDA delivered medicines to 199 people and conducted 297 home visits in the Nicaraguan districts of Managua, León, and Chinandega.

"Thanks to the support of ANICP + VIDA, I can access my ART without risking a COVID-19 infection,” says Marcos, an HCTP client. “I feel very satisfied with the service and support."

Home visits in Panama

Juanita*, 28, lives in Chiriquí, Panama, near the Costa Rican border. Each month she travels four to five hours, first by taxi then by bus, to visit an HIV clinic and pick up her ART medication. She has diligently kept up with her medical appointments and medicines despite the distance and her limited financial resources.

But when COVID-19 began to spread in Panama, she could no longer travel.

“I called Juanita to coordinate the delivery of her medication,” says Sayllin Martínez, an adherence promoter at David’s Integral Care Clinic. “She was worried about not taking her treatment.”

So Martínez went the extra mile, literally, to ensure Juanita and clients like her receive their medication during the COVID-19 pandemic.

“To deliver medication, each patient is visited at home and asked to submit and sign paperwork that allows us to pick up the medication at the David Clinic's Pharmacy,” Martínez says. “After obtaining the medicine, we return to each patient’s home to drop it off. In Juanita’s case, the process took me two hours and 50 minutes each way.”

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.

* Not her real name.

By Claudia Guzmán

Graphic Design and Communications, HIV Care and Treatment Project

USAID HIV Care and Treatment Project HIV & AIDS Health Workers El Salvador Guatemala Honduras Nicaragua Panama

A client received HIV medication at their home in Guatemala in August, 2017. Photo by Anna Watts 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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mHealth Tool Is Keeping Central American Clients Connected to HIV Care amid COVID-19 Shutdowns

mnathe — Wed, 01 Apr 2020 14:18:39 +0000

mHealth Tool Is Keeping Central American Clients Connected to HIV Care amid COVID-19 Shutdowns mnathe April 01, 2020 April 01, 2020

In Central America, frontline health workers are using IntraHealth International’s mobile phone-based alerTAR system to let HIV clients know when, where, and how they can keep getting their antiretroviral therapies (ART), now that public transit and outpatient services in the region have halted due to the COVID-19 pandemic.

These closures and shutdowns are leaving many clients unsure about where to pick up their medications and making it difficult for them to adhere to their HIV treatment regimens. So IntraHealth’s USAID HIV Care and Treatment Project repurposed its alerTAR system—a low-cost, CommCare-based tool that helps health workers at 26 ART clinics in El Salvador, Guatemala, Honduras, and Panama send treatment reminders via SMS—to reach thousands of clients who may be cut off from their usual health facilities and connect them to distribution points for retrieving their lifesaving medication.

Clients who receive SMS reminders are 80% more likely to reach viral suppression.

“Our alerTAR system was originally designed to send appointment and medication reminders, but COVID-19 introduced new challenges for keeping people living with HIV on treatment,” says IntraHealth’s Ricardo Lopez, the Guatemala-based IT advisor on the project who upgraded alerTAR for COVID-19 response. “Because contact information for some 10,000 HIV clients was already set up in alerTAR, we have been able to quickly roll out mobile outreach to HIV clients, letting them know if their nearest clinic or laboratory is closed, whether there are alternative hours or a contact number for making a new appointment, and most importantly where they can go to pick up their prescriptions while services are suspended.”

Central America is home to around 145,400 people who live with HIV, less than half of whom (70,200) are on ART. As of March 30, there were 1,198 cases confirmed cases of COVID-19 in the region, according to the Sistema de la Integración Centroamericana (SICA).

alerTAR allows health workers to send SMS appointment and medication reminders directly to ART clients’ mobile phones. The system triggers alerts for health workers when a client has missed appointments and is at risk of falling off treatment.

“We’ve found that clients who receive SMS reminders about their appointments and medication are 80% more likely to reach viral suppression,” says Ricardo Mendizabal, the project's senior HIV/AIDS advisor. “The percentage is even greater among key populations—men who have sex with men, for example, are 190% more likely to reach viral suppression than clients who don’t receive the SMS messages through alerTAR.”

In this emergency due to COVID-19, alerTAR has become more useful and effective.

IntraHealth’s Central America team has also moved quickly to provide health workers—including community liaisons and facility-based adherence promoters and data clerks—with the guidance on biosafety and personal protective equipment they need to keep working and stay safe while delivering ART to clients in their homes and communities during the pandemic.

“In this emergency due to COVID-19, alerTAR has become more useful and effective,” says Ibe Isael Martir, a community liaison at Hospital Saldaña in El Salvador. “Since March 19, 41 patients have been treated and retrieved their ART and all of them stated that it was the message on their cell phone that reminded them of their appointment and motivated them to come for their medication despite the state of emergency and closure of the hospital for outpatient services. All of them received a two-month supply of medication to last for March and April and a new appointment was scheduled. All have expressed appreciation for the quality care they’ve received in this time of global crisis.”

The HIV Care and Treatment Project is led by IntraHealth International with funding from the United States Agency for International Development. alerTAR uses Dimagi’s CommCare mobile data collection platform.

Resources

COVID-19 Response Brief

El Salvador Guatemala Honduras Panama HIV & AIDS COVID-19 Digital Health Global health security Health Workforce & Systems Community Health Workers USAID HIV Care and Treatment Project

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

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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New Project Will Bring High-Quality HIV Services to the People Who Need Them Most in Five Central American Countries

intrahealth — Tue, 07 Aug 2018 22:19:44 +0000

New Project Will Bring High-Quality HIV Services to the People Who Need Them Most in Five Central American Countries intrahealth August 07, 2018 August 07, 2018

IntraHealth International will expand its HIV prevention, care, and treatment efforts in Central America with a new $15 million award from the U.S. Agency for International Development. The Strengthening Care and Treatment Cascade Project will help El Salvador, Guatemala, Honduras, Nicaragua, and Panama improve the quality and reach of their HIV services and allocate more resources where they are most needed.

While the overall HIV prevalence is low in these countries, the epidemic is concentrated among key groups, including men who have sex with men, transgender women, and female sex workers. Despite these realities, health policy and practice have continued to prioritize testing and treatment for the general population and pregnant women over these groups.

IntraHealth and our partners will focus on reaching these clients with high-quality, stigma-free services and work together to enroll and retain as many people living with HIV as possible on treatment. The project will also prioritize identifying and treating common HIV comorbidities, including tuberculosis.

Every client—regardless of background, gender, or status—must be able to expect and receive respectful, high-quality health services, without bias.

All five countries support the UNAIDS 90-90-90 goals (90% of HIV-positive people knowing their status, 90% of people diagnosed with HIV on antiretroviral therapy (ART), and 90% of clients on ART achieving viral load suppression by 2020). Among the project countries, 64% of people estimated to be living with HIV have been diagnosed. However, only an estimated 37% who know their status are on ART (22%-53%), and less than 25% of those on treatment have achieved viral suppression.

“We need sustainable approaches to truly end the HIV epidemic in Central America, including improving quality and reducing stigma and discrimination,” says Yadira Villasenor, IntraHealth’s chief of party and regional director. “Every client—regardless of background, gender, or status—must be able to expect and receive respectful, high-quality health services, without bias. We must work at all levels of the health sector and in our communities to achieve this.”

The project will:

Help health facilities, partners, and community-level organizations that work with key populations to set, prioritize, and reach their objectives, and sustain interventions
Address stigma, gender discrimination, and other forms of discrimination, as well as gender-based violence
Retain people living with HIV in care by addressing barriers to treatment adherence
Promote evidence-based decision-making by ensuring that complete, timely, and useful information is available to people living with HIV and health workers.

IntraHealth will collaborate with the ministries of health, social security institutes, and National AIDS Programs in each country to address HIV-related policies, set priorities, and provide services. IntraHealth’s local partners include Asociación de Salud Integral, Colectivo Amigos Contra El Sida, and Entre Amigos. This work extends and builds on the successes of IntraHealth’s USAID Central America Capacity Plus (CAMPLUS) Project.

El Salvador Guatemala Honduras Nicaragua Panama HIV & AIDS USAID HIV Care and Treatment Project

In Central America, New Adherence Promoters Keep HIV Clients on Treatment

cbales — Fri, 02 Mar 2018 15:47:23 +0000

In Central America, New Adherence Promoters Keep HIV Clients on Treatment cbales March 02, 2018

March 02, 2018

Carlos considered dropping out of everything. Then he met Aracely, an adherence promoter.

Carlos* remembers the exact date he found out he was HIV-positive. He was 20 years old.

“January 20, 2015. I was walking with some friends and, over in the square, we saw a tent where they were giving HIV tests,” he says. “As a group of nursing assistants, we said, ‘Let’s do this! Why not?’”

Carlos sat alone as he waited for his results. He was #45 in the queue that day.

“When they told me I needed additional tests because my results were reactive to virus, I felt my world falling apart,” says Carlos. “I put on my best smile when I met back up with my friends, but the only thing I wanted to do was go home and break down.”

HIV in Guatemala

Approximately 46,000 people are living with HIV in Guatemala. The adult HIV prevalence rate is low at 0.5%, but since 2010, new HIV infections have increased by 167% and AIDS-related deaths have increased by 23%. Stigma and discrimination, limited access to health care, and migration make the Central America region vulnerable to a growing HIV epidemic.

Just 36% of people living with HIV in Guatemala are enrolled in antiretroviral treatment (ART) and only about 65% of people on ART are adherent—taking their medication every day, exactly as prescribed—as measured by their viral load. ART adherence is required to suppress viral load and reduce risk of HIV transmission, avoid virus mutation and drug resistance, and prevent AIDS-related infections. Sustained ART adherence has profound effects on overall health and prevention of transmission.

Just 36% of people living with HIV in Guatemala are enrolled in antiretroviral treatment

IntraHealth International is working with health facilities and communities in Guatemala and other countries in Central America to improve the lives of people living with HIV and achieve the UNAIDS 90-90-90 goals (90% of HIV-positive people knowing their status, 90% of people diagnosed with HIV on ART, and 90% of clients on ART achieving viral load suppression by 2020).

The USAID Central America CapacityPlus Project (CAMPLUS) helps HIV care units in hospitals and other facilities improve their HIV testing, care, and treatment services, and improve adherence to ART among HIV-positive clients.

“I came with a very low weight.”

In March 2017, more than two years after being diagnosed with HIV, Carlos went to a Comprehensive Care Unit in Guatemala City. “I came with a very low weight,” he says.

Carlos started on a new HIV medication. And although he suffered some side effects, he kept up with his treatment.

He was still working as an assistant nurse and living in the city with his parents and 12 brothers. After starting ART, Carlos told family that he was HIV-positive. They supported him right away.

A few months later, Carlos noticed his lymph nodes were swollen. He went to see a doctor and found out he had tuberculosis. He had to stop the treatment he was on and start another medication.

“This was a very hard blow,” he says. Even worse, the health center where he was treated reported Carlos's diagnosis to the hospital where he worked. He was immediately fired.

Carlos fell into a deep depression. “Absorbing what happened to me was very difficult. I considered dropping out of everything,” he says. “I didn’t have the strength to keep going.”

Adherence promoters

To get more HIV-positive people on ART, and ensure they take their medication properly, CAMPLUS introduced new, facility-based health workers called adherence promoters in 2015.

The project trained and deployed 27 adherence promoters to work across 30 HIV clinics in Central America—including seven clinics in Guatemala—to provide counseling to people living with HIV who are newcomers to the clinic or recently started ART. Adherence promoters 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, 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.

Aracely Zometa has been an adherence promoter since 2016 and works in the San Juan de Dios Hospital Comprehensive Care Unit.

“Aracely is a wonderful person. From her I learned to enjoy life again,” Carlos says.

“Some patients are very adherent,” she says. “To them I speak candidly and advise them to not let up. And that having an undetectable virus load does not mean skipping pills, or not using a condom.”

Aracely noticed one of her clients—Carlos—needed to focus more on his treatment. “He’s a very active person, and always concerned about others. I told him that he has to get some rest and be concerned about himself,” she says.

After many hours talking with Aracely at the Comprehensive Care Unit, Carlos has remained adherent to treatment. His viral load is currently undetectable.

Adherence promoters in Central America have helped retain more than 4,000 people at risk of dropping out of ART.

“Aracely is a wonderful person. From her I learned to enjoy life again,” Carlos says. “She always asks about my life, how I am doing at school. Her support has been crucial for me.”

Together adherence promoters and community liaisons in Central America have retained more than 4,000 people at risk of dropping out of ART (73% of all potential dropouts identified) and have recovered 2,570 people who had dropped out of treatment.

These positive results motivated the Ministry of Health of Panama to absorb some of the adherence promoters into its budget. Other ministries in the region are making similar efforts.

Carlos is now a nurse in the intensive care unit in a private hospital located in one of the wealthiest zones in the city.

He says society is still not prepared to fully accept people living with HIV. “I was also part of the crowd and knew nothing. [Before], when I had to care for a person living with HIV, I did so in a very fearful manner,” he says.

Nowadays one of Carlos’s goals is to become an expert on caring for people with HIV. He’s also working to combat stigma and discrimination. “People lack education,” he says. “I found a course offered by a university in Guatemala. It specializes in HIV, and I hope I can take this course in the next year.”

*Name has been changed to protect the individual's privacy.

Renato Hernandez contributed reporting for this story.

HIV data for this post is from the UNAIDS 2016 Guatemala fact sheet.

By Carol Bales

Strategic communications manager

Central America CapacityPlus Project HIV & AIDS Health Workers Guatemala

Aracely Zometa is an adherence promoter in Guatemala and works in the San Juan de Dios Hospital Comprehensive Care Unit. Photo by Anna Watts for IntraHealth International.

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In Central America, Health Workers and Communities Achieve Big Progress in the Fight against HIV

intrahealth — Wed, 07 Feb 2018 17:14:35 +0000

In Central America, Health Workers and Communities Achieve Big Progress in the Fight against HIV intrahealth February 07, 2018 February 07, 2018

IntraHealth International is in the final months of an intensive two-and-a-half-year collaboration with government agencies, nongovernmental organizations, and civil society groups in El Salvador, Guatemala, Honduras, and Panama to accelerate progress toward reaching the UNAIDS Fast-Track targets and ending the AIDS epidemic—and the results from the first two years are striking. IntraHealth’s local partners administered 186,471 HIV tests, reached 35,599 people living with HIV with critical care and treatment, and drastically improved client adherence to antiretroviral therapy (ART) through our USAID Central America Capacity Plus (CAMPLUS) Project.

Central America’s epidemic is currently concentrated in key populations, such as men who have sex with men, transgender women, and sex workers. Stigma and discrimination, limited access to health care, and migration all make the region vulnerable to a growing epidemic that could threaten the region’s significant progress toward achieving the UNAIDS 90-90-90 goals (90% of HIV-positive people knowing their status, 90% of people diagnosed with HIV on ART, and 90% of clients on ART achieving viral load suppression by 2020).

Partnering with health workers and communities and giving them the tools to identify and address problems they’re best positioned to solve is what’s making a difference in reaching those most vulnerable.

“Violence in communities, stigma and discrimination, economic factors, and distance to facilities are just some of the many challenges that keep people in need of HIV services from getting them,” says Yadira Villasenor, IntraHealth’s regional director of Central America and chief of party of CAMPLUS. “Partnering with health workers and communities and giving them the tools to identify and address problems they’re best positioned to solve is what’s making a difference in reaching those most vulnerable.”

IntraHealth worked side by side with the countries’ ministries of health, national AIDS programs, health facilities and providers, and multisector community-based networks to strengthen both facility- and community-based approaches to reaching the UNAIDS targets and improving the lives of people living with HIV.

Together, we were able to:

Provide 186,471 HIV tests
Deliver care and services to 35,599 people living with HIV
Enroll 5,552 additional HIV-positive clients in ART
Retain 4,000+ clients at risk of dropping out of ART and recover 2,750+ people who had dropped out of treatment
Increase adherence to ART (measured by viral load) to 74% of eligible clients in project-supported facilities (compared to 56% on average in facilities not working with the project).
Reduce stigma and discrimination in health facilities, culminating in 93% of HIV-positive clients reporting receiving respectful, discrimination-free services at project-supported sites
Strengthen facility and community-based strategies—including training and supporting adherence promoters in 30 facilities and community liaisons in 15 geographic areas—for linking people living with HIV to services and recovering those who drop out care and treatment.

The project achieved these results while also helping its local partners build better human resources management practices in health facilities, report on and use data for evidence-based decision making, and institutionalize an approach called Optimizing Performance and Quality (or OPQ), for identifying and addressing quality and performance gaps on an ongoing basis. Thirty-one health facilities across the four countries are now using OPQ to identify and fix performance issues.

IntraHealth began working with Belize, Costa Rica, El Salvador, Guatemala, and Panama to strengthen the region’s response to the HIV epidemic through the USAID Central America Capacity Plus (CAMPLUS) Project in 2011. In 2016, the project shifted its focus to helping El Salvador, Guatemala, Honduras, and Panama implement the Fast-Track Approach to ending the AIDS epidemic by 2030 and improving the lives of people living with HIV by implementing the Continuum of Care Cascade model. Results reported are from October 2015 – September 2017.

El Salvador Guatemala Honduras Panama HIV & AIDS Community Health Education & Performance Health workforce developmentHealth workers in the HIV clinic at Juan José Ortega National Hospital in Coatepeque, Guatemala. Photos by Anna Watts for IntraHealth InternationalCentral America CapacityPlus Project

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