Improving and Expanding Access to and Uptake of HIV Testing and Counseling (HTC) Project

Behind Big Results in Zambia, Big Ideas and a Creative Team

mnathe — Thu, 30 Aug 2018 19:22:31 +0000

Behind Big Results in Zambia, Big Ideas and a Creative Team mnathe August 30, 2018

August 30, 2018

Meet some of the people who’ve been driving major progress in HIV care for members of Zambia’s hard-to-reach key populations.

Five years is a very short period in the grand scheme of things. But when the right people work together toward a common goal, great things can be achieved.

Great things like reaching 738,951 people with HIV testing and counseling. And of the 10% who tested positive, getting 87% initiated on antiretroviral therapy (ART) to help treat the disease.

This is what happened in Zambia, where IntraHealth International has been working to improve HIV testing and counseling and expand access to those services in rural and underserved districts. But it would be short-sighted to talk only about the numbers.

I’d rather talk about the people who achieved these results, and the numerous initiatives they undertook to engage the community as they achieved them.

How to reach the hard-to-reach

IntraHealth’s team in Zambia worked with women and babies, yes—many women become more engaged in their health the second they learn they are pregnant, as they want to ensure their babies are safe and healthy—but men are often harder to reach, more reluctant to adopt healthful behaviors or seek treatment for sickness. Go to the health facility along with wives and screaming babies and children? No thank you.

So the team had to strategize.

Raymond Havwala, the male engagement officer, used an approach called Healthy Images of Manhood to work specifically with men, teaching them in focus groups how to take care of their own health, and discussing their respective issues together in a comfortable and familiar environment. One of the men Raymond met during these meetings made a particularly striking remark:

“The HIM meetings helped me face my fears about taking an HIV test,” he said. “I got tested and I was immediately started on ART. This has helped me gain weight and better protect my family. The information about the benefits of being consistent with my treatment and the viral load suppression is the gospel I am now using to bring more men to our meetings.”

The men started to look forward to these meeting and were more and more comfortable talking about health and other things. They even started to address other subjects. Gender-based violence was one dear to Raymond’s heart.

They realized how much they were hurting their partners.

“Gender-based violence is a serious problem in Zambia and is mostly perpetrated by men,” he says. “This problem was also there amongst our participants and needed to be addressed. Our Insaka meeting also revealed that most HIV-positive participants, after being tested, perpetrated violence as they accused their partners of bringing HIV into the home. This was heartbreaking for me as a gender activist. I felt the HIM approach would be a good platform for working on this with the men, and the group responded very positively to the topic. They realized how much they were hurting their partners and how their relationships broke down as a result of accusing their partners after learning their HIV-positive status. This also helped them change their perceptions and live in harmony with each other and especially manage the condition as a couple.”

Raymond received an award in the Gender and Governance Category in recognition of his outstanding contribution to promoting the empowerment of women and ending gender-based violence under the Genderlinks awards in Zambia in both 2012 and 2014. And for this work with men, he received the Men’s Excellence Award under the Government of Zambia.

No one should be left behind, so the team also worked with hard-to-reach key populations, including female sex workers, men who have sex with men, prisoners, and transgender individuals. The program was very successful—they reached almost 70,000 clients from these groups. Among them, 18% tested HIV-positive.

Members of key populations tend to engage in higher-risk behaviors. In Zambian correctional facilities, for example, HIV/tuberculosis coinfection rates are high, and driven by unprotected male-to-male sex, overcrowding, sexual violence, drug use, lack of access to HIV/TB information, and lack of access to condoms/lubricants (which are banned by the government to prevent homosexuality). And upon release, prisoners risk infecting their partners with HIV when they return home.

So once again, the staff had to get creative to reach these groups.

They trained correctional facility officers as well as inmates.

Their initial strategy was to have visiting health workers provide inmates with HIV testing, TB screening, and referrals for those who needed them to in-house ART and TB treatment services. But the inmates’ lack of trust for outsiders hindered the results. So IntraHealth Zambia started a close collaboration with the Ministry of Home Affairs, Correctional Services, to train correctional facility officers as well as inmates in psychosocial counseling. A total of 50 inmates and 50 officers were trained as lay providers to provide HIV testing services directly inside the prison. This peer-to-peer approach was a real success and had a remarkable impact on the team’s results.

You can read more about the team’s results here. But the heart of those results is people—the project staff, the health workers and officials we partner with, and the clients we serve to help end the HIV epidemic in Zambia and build a healthier future for all.

IntraHealth’s Improving and Expanding Access to and Uptake of HIV Testing and Counseling (HTC) Project was funded by the US Centers for Disease Control and Prevention.

By Nadia Lévêque

Former program officer, IntraHealth International

Improving and Expanding Access to and Uptake of HIV Testing and Counseling (HTC) Project HIV & AIDS Community Health Workers Zambia

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HTC Project Brought HIV Services to 800,000 Zambians

mnathe — Wed, 25 Jul 2018 18:23:48 +0000

HTC Project Brought HIV Services to 800,000 Zambians mnathe July 25, 2018 July 25, 2018

Close to 800,000 Zambians received HIV services—including testing, counseling, antiretroviral therapy (ART), tuberculosis screening, and more—through IntraHealth International’s HTC Project, which for five years focused on serving clients who are often the most difficult (and crucial) to reach.

Throughout 2012–2018, the project provided HIV care and services to female sex workers, men who have sex with men, transgendered individuals, prison inmates, couples, pregnant and breastfeeding mothers, adolescent girls and young women, adolescent boys and young men, cross-border traders, seasonal farmers, miners, military and police personnel, fishmongers, and persons with disabilities.

Zambia’s epidemic remains most severe among these groups, so reaching them with the care and services they need is crucial to curbing HIV in the country.

The HTC team used targeted strategies to reach each of these populations. To reach female sex workers, for example, they liaised with the women’s supervisors, known as Queen Mothers. To reach men, who are often less likely to pursue health services, they used the Healthy Images of Manhood approach, a health education program that aims to change the norms around traditional beliefs of masculinity and femininity, particularly in seeking out health care.

738,951 Zambians received HIV testing services and their test results, including 69,679 from key populations.

To accomplish this, project staff trained and worked with the health workers best positioned to reach these clients: lay providers, social behavior change promoters, and community activists. Together we worked in ten districts across Lusaka, Western, and Southern provinces, which have high rates of HIV (prevalence in Lusaka surpasses 16%) to achieve these results and more:

738,951 Zambians received HIV testing services and their test results, including 69,679 from key populations. Among those tested, 10% were HIV-positive.
66,484 (87%) of those who tested HIV-positive were initiated on ART, including 11,920 from key populations.
795,211 individuals were provided with social behavior change communication.
51,118 people living with HIV received ART services through mobile and outreach services.
69,379 (90%) of HIV-positive clients were screened for tuberculosis. 12,877 cases were confirmed, 87% began treatment.
589 lay providers were trained to provide HIV testing services in their communities.
838 health workers from across cadres were trained to address HIV through clinical and psychosocial services, monitoring and evaluation, and more.

IntraHealth’s HTC Project—or Improving and Expanding Access and Uptake of HIV Testing and Counseling (HTC) for Individuals, Couples and Families in Selected Urban and Rural Populations in Lusaka, Western, and Southern Provinces of the Republic of Zambia—was funded by the US Centers for Disease Control and Prevention.

At the International AIDS Conference this week? Stop by booth 220 or come to one of our many sessions to learn more about IntraHealth’s work in Zambia and beyond to end the epidemic.

Zambia HIV & AIDS Community Health Community Health Workers Improving and Expanding Access to and Uptake of HIV Testing and Counseling (HTC) Project

For HIV Clients in Zambia, Referrals Are Life-Changing

mnathe — Mon, 21 Aug 2017 19:47:47 +0000

For HIV Clients in Zambia, Referrals Are Life-Changing mnathe August 21, 2017

August 21, 2017

A simple document from a trained health worker can give clients the courage they need to face the virus head-on.

Hildah Maswabi waits for the health worker to write down her details—full name, address, telephone number, gender, HIV/TB statuses—on her referral form so she can take it to the nearest local health center.

The mood as she waits is somber. Finally, after the lay provider has written and reviewed everything for completeness and correctness, Hildah takes the form with a sigh of relief. It is only when I talk to her that I understand how much it represents to her.

I finally found the courage to come and be tested.

We are in Ngwerere in Chongwe District, a peri-urban area of Lusaka Province, Zambia. This is just one of the sites where IntraHealth International Zambia conducts mobile community HIV testing services.

Hildah’s story is similar to those of a lot of rural Zambians. She is 34, a mother of three children, divorced. She has never gone to school and is a casual worker, taking any job available to her, earning very little. She has lived with her parents since her divorce four years ago.

Hildah is usually a very strong woman, she tells me, but she noticed lately that her health hasn’t been so good. But she couldn’t afford to refuse work. It took her over three months to go to the nearest health post, where she had heard IntraHealth provides HIV testing services on Wednesdays.

“What made you decide to come today?” I asked Hildah.

“I wanted to know my status,” she said. “And here I am. I finally found the courage to come and be tested. Now I know what is going on with me. I am so happy that I finally have a referral and the doctors will help me now.”

Giving the HIV counselors in mobile clinics the power to refer clients to health facilities is one of IntraHealth’s successes in Zambia.

Clients see their referrals as the key to information they need to stay healthy, and as the culmination of all the weeks, months, or sometimes years of summoning the courage to visit the nearest health center.

The fears of stigma and discrimination that emerged with the HIV epidemic in Zambia in the 1980s persist here today. Visiting the hospital, or even the clinical center, is frightening. People find themselves lost in long corridors, some (like Hildah) unable to read, not knowing which sign to follow, and ashamed to ask someone where to go. Fear of stigma makes people like Hildah worry they will be treated poorly if they’re seeking HIV services.

IntraHealth has provided Hildah and many others with a safe environment and direct consultation with trained health workers. The guidance and referrals they receive give them the courage to take the next step, to seek further prevention, care, or antiretroviral therapy (ART) services.

Today with my routine checkups and ART provisions, I can kick anything.

A year later, Hildah is glad she took that first step to get tested.

“My fears were dictated by unawareness,” she says. “Once I came to know that HIV is nothing more than a disease and that it can be controlled by medication, I accepted my status wholeheartedly. Today with my routine checkups and ART provisions, I can kick anything. I feel strong. And that was the beginning of my dream to make my life and my children’s lives better. I believe in this dream. My children have been tested and were found negative.”

But not all children in this community were getting the testing services they need.

Waiting in the queue for HIV testing services that day I met Hildah was a worried-looking family. A woman named Bupe (33) who sells fruits on the side of the road, her husband Anderson Chilumbu (34), a small-time brick layer and a seasonal commercial farm laborer, and their baby boy, who was crying. Bupe had been waiting a long time for her husband to have time away from work so they could come to the health center together and have health workers see their baby.

Unfortunately, the lay providers could not test their son for HIV. The rapid testing kits they use for children aren’t always accurate for babies under two, and so they referred the family to the nearest facility for a dried blood spot test, the recommended testing method for babies under 18 months old.

Bupe and Anderson were not daunted. There was joy on their faces when they finally spoke with the lay provider—someone from their own community who was reassuring and understanding—and were given what they needed: a letter of referral to the health center, where they could get their baby the testing and care he needed. The provider urged them to go as soon as possible.

They did. And as it turned out, they tell us a year later, their son had had severe malaria, and was treated.

“Now, we have a beautiful child whose growth is progressing well,” Anderson says. “The referral letter improved our lives tremendously.”

To help more children get access to the HIV testing and services they need, IntraHealth Zambia has trained lay providers in the ten districts in which it works to provide this service for children 14 years of age and younger. This is one way Zambia is working toward the global targets to reduce new pediatric infections by 90% and population-level mother-to-child infection rates to under 5%. Through our weekly HIV testing sessions, we are working to bring Zambian communities closer to the services and reassurance they need to end HIV stigma and new infections. Jacqueline Kabeta contributed reporting to this piece.

IntraHealth’s work in Zambia is conducted with funding from the Centers for Disease Control and Prevention and PEPFAR under Improving and Expanding Access and Uptake of HIV Testing and Counseling for Individuals, Couples, and Families in selected Urban and Rural Populations in Lusaka, Western and Southern Provinces of the Republic of Zambia.

“My fears were dictated by unawareness,” Hildah Maswabi says. “Once I came to know that HIV is nothing more than a disease and that it can be controlled by medication, I accepted my status wholeheartedly." Photo by Nadia Lévêque.

From left, Anderson Chilumbu, Bupe, and their son. "Now we have a beautiful child whose growth is progressing well,” Anderson says. “The referral letter improved our lives tremendously.” Photo by Nadia Lévêque.

By Nadia Lévêque

Former program officer, IntraHealth International

Improving and Expanding Access to and Uptake of HIV Testing and Counseling (HTC) Project HIV & AIDS Child Health Community Health Community Health Workers Zambia

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A Preacher on a Mission to End HIV in Zambia

mnathe — Mon, 14 Aug 2017 15:43:37 +0000

A Preacher on a Mission to End HIV in Zambia mnathe August 14, 2017

August 14, 2017

Whether he’s on his bike, giving a sermon, or counseling at the clinic, Reverend Lusale is ready to talk to anyone about HIV.

When the first AIDS case struck Zambia in 1984, Reverend Lusale was two years away from graduating from theology school, and did not know the impact the virus would have on Zambians’ lives, or on his own.

At its peak in Zambia in 2001, when 21.5% of the adult population was infected, he realized there was something he could do to help. Reverend Lusale decided to go for training as an HIV counsellor.

Today he works as part of IntraHealth International’s team of lay counsellors in the HIV Testing and Counselling Services (HTS) Program at Ngwerere, a testing and counseling facility in a peri-urban area in rural Lusaka, Zambia. He is one of six lay counselors who counsel clients, test them for HIV and tuberculosis, and refer those that are positive to the nearest health center.

He promotes HIV services during Sunday sermons and for farm workers onsite.

The reverend spends his days on his bike, which helps him reach more people in his community. Every Wednesday, he arrives at the Rural Health Center Community Hall to provide HIV testing and counseling services, and that is where I met him.

But he doesn’t stop there. He also promotes the services during Sunday sermons and, upon request by local commercial farm owners, offers HIV counseling and testing for farm workers onsite. Partnering with community leaders like Reverend Lusale makes a big difference in Zambia’s ongoing battle against HIV and tuberculosis—he brings dedication, the trust of his community, and the reach of his pulpit.

Ngwerere has a population of 13,873 and a 12% HIV prevalence rate, according to the district medical officer. It is one of seven high-HIV-burden districts within Lusaka, Southern, and Western provinces where IntraHealth now provides HIV testing and counseling services. The HTS program offers dedicated services for those at higher risk of HIV infection, including female sex workers, men who have sex with men, prisoners, adolescents, pregnant women, couples, and vulnerable mobile groups and minors.

Where demand for services among these groups is high, health workers offer HIV testing services door-to-door at lodges, the houses of female sex workers, busy markets, and border posts. They also provide testing for LGBTI (lesbian, gay, bisexual, trans, and/or intersex) groups. Clients gather at a central safe space and are provided group counseling and individualized services.

Reverend Lusale is unashamedly candid about his work. He interacts with anyone and everyone, including local sex workers, and listens to and answers every enquiry.

“You know, actions speak louder than words,” he says. “So we are teaching people in a safe environment how to use condoms.”

I asked him if being a man of God made it difficult for him to promote condom use.

“If I do nothing, I am killing my people!” he says. “I tell my people to use condoms because that is the right thing to do to save their lives. And since I am also the chairman for the Apostolic Pastors Fellowship in Ngwerere, I tell other pastors that giving condoms is good. Counseling skills have helped me a lot in my ministry—I am now counseling other clergymen. I have even spoken to my son and said to him, ‘If you want to have some of these condoms, take and give some to your friends!’”

I feel so grateful to help relieve the HIV burden of this community and our people.

One year after we first met, I return to the same local clinic, in one of the most HIV-affected areas in Ngwerere. I find Reverend Lusale at the ART section, following up on his previous referrals.

“Keeping track of even one person after testing for HIV can be complicated, but heartwarming,” he says. “The team has had to aggressively mobilize and learn on-the-go in order to be responsive to the specific needs of the community, and each of us wears several hats. There is so much to be done amidst high poverty levels, fears of stigma, and limited resources, but I am so proud of the work we are able to accomplish.”

He looks at me with a piercing gaze, as if to assess whether I understand. I do.

Being in a rural community, coping with such great need for HIV services and a seemingly ill-prepared health center magnifies the complexity of the services. But he and his team are using the training they gained through IntraHealth Zambia to follow up on all referrals and working with the health center partners to implement best practices for referred clients—including around complex issues such as access to antiretroviral therapy, CD4 count delays, stock-outs of HIV testing kits, and monitoring data on the epidemic to inform planning.

“I feel so grateful for the opportunity to serve and help relieve the HIV burden of this community and our people,” he says. “IntraHealth is doing amazing work in our communities and I feel so fortunate to be a part of it.”

Today Zambia’s HIV prevalence rate has fallen to 12.9% among adults aged 15–49, thanks to Reverend Lusale and others. It is only with dedicated people like him that Zambia will see the end of the virus.

IntraHealth’s Improving and Expanding Access to and Uptake of HIV Testing and Counseling Project is funded by the US Centers for Disease Control and Prevention. Jacqueline Kabeta contributed reporting to this piece.

By Nadia Lévêque

Former program officer, IntraHealth International

Improving and Expanding Access to and Uptake of HIV Testing and Counseling (HTC) Project HIV & AIDS Community Health Community Health Workers Zambia

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