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Getting to Zero, but Starting from What in South Sudan?

Earlier in the month, we celebrated World AIDS Day with messages such as “getting to zero,” and ‘the end of AIDS.’ In a fledgling country like South Sudan, figuring out how to get to zero means knowing what you are starting with.

The current estimated prevalence in South Sudan is 3.1%, according to the Centers for Disease Control and Prevention (CDC). Compared to many African countries, it’s low. Many of South Sudan’s neighbors—Uganda, Kenya, Ethiopia, Democratic Republic of Congo—have higher HIV prevalence. However, with great improvements in security and stability, starting with the signing of the Comprehensive Peace Agreement in 2005 and then official independence of South Sudan earlier this year, people are much freer to move within South Sudan and across its borders. This necessitates a redoubling of HIV prevention efforts to keep prevalence low, and ideally take it to zero.

IntraHealth International started working in what was then called ‘Southern Sudan’ in 2006 with support from CDC. Initially, we focused on supporting the Sudan People’s Liberation Army (SPLA) HIV Secretariat to help raise awareness of HIV and AIDS among its soldiers, who were mostly young and male, and to encourage them to be tested for HIV. Over a matter of just a few years, the SPLA succeeded in transforming its operation from one with few personnel trained in HIV prevention and treatment, and little infrastructure to support this work, to one that hosts one of the few antiretroviral (ARV) therapy centers in South Sudan. It’s quite an accomplishment.

You can view a slideshow that captures some of this work here.

Looking back over the last six years, we can see the tremendous strides the SPLA Secretariat made to develop its human capacity, infrastructure, and HIV prevention and care services. The project has succeeded, in part, because of its ability to consult with the military leadership and ensure the services are relevant to the military’s specific needs. One of the IntraHealth staff’s aims in this collaboration has been improving the qualification of service providers through formal and in-service training, taskshifting, and coaching from military-to-military exchanges.  Recognizing that there were very few qualified medical doctors within South Sudan, let alone in the SPLA medical corps, IntraHealth worked with the medical corps to shift HIV counseling and testing as well as adherence counseling work to trained counselors.

For example, IntraHealth oversaw the training of over 875 people in HIV/AIDS prevention. Clinical officers were also trained in HIV/AIDS management and began providing consultations with patients, dispensing ARV drugs, and providing the patient recordkeeping to lessen the demand on other medical personnel, who are otherwise required to carry out these activities (i.e. doctors). IntraHealth also helped organize a study tour to Uganda and Kenya for thirteen SPLA generals to learn about the successes of the HIV/AIDS programs in the Uganda People’s Defence Force and Kenya Defence Forces. Subsequently, Kenyan and Ugandan military officials visited South Sudan to continue the collaboration on HIV prevention strategies and practices. 

Further successes in the arena will depend on the rebuilding of the health system and critical data collection and monitoring systems to help us understand what works well and what doesn’t. To this point, we were excited to see an article a couple of months ago from, “South Sudan: Using DevInfo to Establish Foundations for Data Management.This type of work in “helping to lay the foundation for a data-driven decision-making approach in South Sudan” and “in building national capacity in DevInfo use and in creating a customized country database to support the monitoring of national development” is exactly the kind of work we need to continue to move ahead with successful programs or tweak them as we need to.

On a smaller scale, IntraHealth developed and is using a web-based data system for tracking key indicators and outcomes of this work, including some of the PEPFAR New Generation indicators. This system organizes, stores, and presents data and, since it is web-based, offers real time access from remote sites as far away as IntraHealth’s headquarters in the US. The information is entered centrally at IntraHealth’s Juba office and is used to inform and improve the HIV prevention services the project offers. The data is also shared with the Ministry of Health and could easily be included in any new national database being considered/developed by the government of South Sudan.  We hope one day that our data combined with data from all public and private partners providing HIV/AIDS services will be used to help steer national policy and decision-making.

Although our focus is on training and equipping health workers to offer HIV prevention, counseling and testing, and treatment, at the end of the day we want to know if our work is changing patients’ lives. We want to know if we are preventing new HIV infections. We want to be working ourselves out of job, at least on the HIV/AIDS front, and that means tracking how we can get to zero—zero new HIV infections.