Ending AIDS by 2030 means removing bottlenecks to care and treatment – but what causes them?

The expansion in the provision of life-saving antiretroviral therapy (ART) in sub-Saharan Africa over the past fifteen years has been an unprecedented achievement for public health, resulting in dramatic declines in HIV-related deaths and disease.

By 2015, just over half of the 10 million people living with HIV in sub-Saharan Africa were accessing ART, paving the way for the Joint United Nations Programme on HIV and AIDS (UNAIDS) to launch a bid to eliminate AIDS by 2030. This would require that 90% of people living with HIV (PLHIV) are diagnosed, 90% of those diagnosed then initiate ART, and 90% of those on ART adhere to their treatment sufficiently well as to achieve viral suppression.

This week, Paris is hosting the International AIDS Society conference. The event provides a further catalyst for rolling out policies to achieve the 90-90-90 targets, so now is a good time to take stock and examine how the most affected countries address the challenges in meeting them.

Making ART available for all PLHIV+ is a huge step forwards towards eliminating AIDS, but significant stumbling blocks remain. Many people do not feel ready or willing to undergo a HIV test, and those diagnosed may not feel able to take the daily drug regimens for the rest of their life. Understanding and addressing the reasons for existing barriers in HIV care and treatment is critical to achieving a future free of AIDS.

Contextual, social and health system factors influence the engagement of PLHIV with HIV care and treatment in sub-Saharan Africa, but how? Our ‘Bottlenecks’ study published in the journal Sexually Transmitted Infections has provided crucial insight. Funded by the Bill & Melinda Gates Foundation, the multi-country qualitative study examined the bottlenecks to HIV care and treatment at seven sites in six African countries; Kenya, Uganda, Tanzania, Malawi, South Africa and Zimbabwe.

Uniquely we were able to draw on locally available census data linked to HIV clinic records. This meant we could identify and interview PLHIV with different HIV care and treatment histories, including those who had disengaged from the HIV care process and family members of PLHIV who had died. Such groups are notoriously difficult to include in qualitative studies. As a result, their voices and stories are often missing from accounts of HIV service use, resulting in policy recommendations that focus on those who face fewer challenges to HIV care engagement.

We found that interactions between patients and health workers, who are often desperately overworked and underpaid, had a huge influence on care seeking. In some cases, health workers believed themselves to be considering the patients’ best interests when using persuasive tactics to increase the number of patients undergoing HIV tests. Health providers, in an effort to achieve viral suppression, are also often failing to recognise the impact of debilitating side-effects that PLHIV endure on their engagement in HIV care.

Furthermore, we found that many PLHIV consult with alternative and traditional healers, although this was rarely accepted within the biomedical sector. Health workers must accept patients’ desires to access multiple channels in order to reduce the conflicts and confusions which culminate in bottlenecks.

Another major issue that affected engagement with HIV services across all settings related to couples’ relationships. For many, fear of blame, abandonment or abuse resulted in an unwillingness to disclose their HIV status to each other. Even among mutually disclosed couples there was little scope for them to attend appointments together, or to collect drugs for their partner if they were too busy themselves.

Finally, and perhaps most importantly, despite improvements to HIV care services and over a decade of HIV care provision, stigma remains a persistent barrier, not only within couples but also within the community at large. This is undermining engagement with HIV diagnosis, care and treatment in all of our study settings.

As we move towards universal ART, greater acknowledgement of these issues is required. But these are exciting times – there are several bold and imaginative approaches to address these concerns on the horizon.

Self-testing for HIV is enabling many underserved groups to learn their HIV status, and continued decentralization of care and task-shifting to lay and peer health workers is breaking down barriers to accessing treatment. Patient-centred care that recognises different patients have different needs is beginning to take precedence over the previous one-size-fits all approaches that we have seen until now. New family-centered models of care are also being proposed to enable PLHIV to not only test together, but to also collect drugs for themselves and their partners.

These approaches must be tried, tested, revised and scaled-up in order to unblock the persistent bottlenecks to HIV care and treatment. Only then the ambitious goal of AIDS elimination by 2030 can be reached.

Dr Carolyn Gomes accepted to serve on the developing country NGO delegation to Global Fund board

The Global Forum on MSM & HIV (MSMGF) announced that three members of The Consortium of MSM and Transgender Networks, Dr Carolyn Gomes, Simon Cazal, and Berry Nibogora, have been accepted to serve on the developing country NGO delegation to the Global Fund board.

Dr Carolyn Gomes is the Executive Director of Caribbean Vulnerable Communities (CVC), a PANCAP partner. Her work drives policy analysis, advocacy and resource mobilization to support services to vulnerable communities. Her organization, CVC, currently provides grants and technical support to a number of countries across the Caribbean islands and mainland territories.

Read more about CVC here.

Since its convening in 2013, The Consortium has reached communities of men who have sex with men, transgender people and other key populations in more than 60 countries worldwide, thanks in part to a grant provided by the Robert Carr Civil Society Network Fund (RCNF). Over the past two and a half years, members of The Consortium took aim at specific obstacles impeding meaningful engagement of men who have sex with men and transgender people in Global Fund processes at country level. Specifically, the Consortium increased community involvement of key populations in national AIDS planning processes and created direct links with Global Fund personnel. CVC led the development of the Jamaica Civil Society Forum that helped reform the CCM, including creating a civil society chair.

“We are very encouraged to see that the Global Fund is working to meaningfully include men who have sex with men and other community advocates in their programmes, policies, and funding initiatives,” said Dr George Ayala, Executive Director of The Global Forum on MSM & HIV (MSMGF). “We are proud to be a part of facilitating linkages between local advocates and global policy processes, ensuring that local needs continue to shape the global AIDS response.”

MSMGF stated that it is confident that the advocates’ experience, perspectives, and skills will greatly benefit both the Global Fund and key populations worldwide. MSMGF pledged support to their work on the delegation and wished all Global Fund NGO delegation members success in the work that lies ahead.

PANCAP Knowledge Coordinator conducts STI Management Training

PANCAP Knowledge Coordinator, Dr Shanti Singh-Anthony, facilitated the Ministry of Public Health (Guyana)’s ‘STI Management’ training in July. Dr Singh-Anthony explained that the training was pivotal at a time when the landscape of STI infections is changing and doctors are required to significantly enhance their knowledge capacity regarding the treatment of STIs.

More than twenty (20) doctors from the Ministry of Health participated in a series of presentations and interactive group sessions facilitated by Dr Singh-Anthony held at the Georgetown Public Hospital (GPH).

The topics discussed included strategies for prevention and control of sexually transmitted infections. Participants were encouraged to utilize the 5Ps ( Partners, Practices, Prevention of Pregnancy, Protection from STIs and Past History of STIs) recommended by US Centers for Disease Control, in conducting a comprehensive risk assessment. Emphasis was placed on understanding prevention methods and the value of biomedical prevention such as HPV and Hepatitis B vaccinations. Expedited Partner Therapy (EPT) was prioritised as a critical intervention in the control of STIs. Diagnosis and management were presented using WHO recommended syndromic management approach and addressed genito-urinary discharge syndrome and genito-ulcer disease. These were presented as case studies.

Dr Singh-Anthony explained, ‘it is vital that doctors make use of the new research, literature and data available to consistently upgrade their knowledge of the new advances in the treatment of STIs. The science associated with the treatment of STIs is constantly changing and doctors must keep up with the advances in order to effectively treat patients and improve their health outcomes’.

NAC Belize hosts Key Populations Capacity Building Work Sessions

In July the National AIDS Commission (Belize) and the Caribbean Vulnerable Communities Coalition (CVCC) partnered on several training sessions designed to empower and strengthen civil society organizations (CSOs), non-governmental organisations (NGOs) and key populations involved in the HIV and AIDS response in Belize. These sessions were done in Belize City and Dangriga Town, which are considered high burden areas. The main objectives of the sessions were:

– To have greater support and involvement of CSOs in the HIV and AIDS response
– To strengthen linkages between communities and the health care systems
– To identify barriers, gaps, areas of synergy, and future action that will assist in reaching the 90-90-90 targets

The sessions entitled ‘Reaching the 90-90-90 targets in the Caribbean through Local Authority and Civil Society Partnerships’, were facilitated by Dr Carolyn Gomes, Executive Director of CVCC and her co-facilitator Ms Kandasi Levermore, Executive Director of Jamaica AIDS Support for Life (JASL). These were completed in Belize City on July 18th-19th and in Dangriga Town on July 20th-21st and focused primarily on how to achieve the treatment targets for the Caribbean and provided an in-depth overview of the HIV and AIDS situation in the Caribbean and Latin America as well as exploring the achievement of the 90-90-90 targets by 2020.

In her discussion, Dr Gomes explained that in 2015, donors provided governments with $7.53 billion US dollars for HIV Programmes, a 13% decline in funding since 2014 due to competing priorities, humanitarian emergencies, refugee crises, and fiscal austerity among other factors. As funding gaps threaten to derail the response to HIV patients, countries will increasingly need to fill gaps and find more efficient and cost effective ways to fund their response. A survey of HIV focused organizations, conducted by UNAIDS in 2012 and 2013, revealed that the majority of respondents reported experiencing decreases in funds for HIV and human rights related work.

The experiences with the PANCAP Round 9 Grant work with CSOs reveal that there is a need for greater prioritisation of key interventions that are evidence based and target individuals at highest risk, as well as the need for early and wide dissemination of findings and frank discussion of epidemiological data. NGOs and other implementers need to be provided with guidance on the focus their programmes should adopt as well as build local authority and civil society partnerships for greater success.

Dr Gomes and Ms Levermore spoke about the need for a collaborative response in order to reach collective national and regional goals. With regard to CSOs and government, there needs to be a strengthening of dialogue in order to have more partnerships and collaboration between all parties.

On July 26th the National AIDS Commission, Centro de Orientacion E Investigacion Intergral (COIN) and CVCC collaborated to address the needs and capacities of the populations served by the NAC during a one-day session entitled: ‘Challenging Stigma and Discrimination to improve access to and quality Of HIV Services in the Caribbean’.

Mr Ivan Cruickshank, CVC representative and programme facilitator opened the session with a statement of intent and the shared programme objectives which were to review and assess agency/country specific advocacy plans, to assess relevance in response to changing circumstances; to improve knowledge sharing among partner agencies, share lessons learned so others can benefit from their experiences; to develop a National Advocacy Plan using data (both quantitative and qualitative) to inform advocacy, and make arguments that support policy proposals to help make advocacy efforts more viable. The exercise included the development of effective advocacy messages specifically for target audiences.

The purpose of the session was the empowerment of advocates to move their agendas forward, hence local agencies were asked to present on their experiences within Belize and how systems help to uphold their rights and causes. Presenting agencies were: UNIBAM, CNET+, PETAL, Our Circle and TIA Belize. After the presentations and group discussion, Mr Cruickshank engaged participants in the development of a national advocacy action plan which focused on alleviating treatment care and support issues for populations, to promote legislative reform that advances anti-discrimination, stream line health services for key populations and to highlight the effects of adult ARVs on children which were tied to increasing the number of persons accessing and retained on treatment country wide to contribute to the 90-90-90 Targets.

From July 27th to 28th, the NAC and CVC embarked on a CSO directed Legal Literacy workshop as a part of a three-year regional project entitled ‘Challenging Stigma and Discrimination to Improve Access to and Quality of HIV services in the Caribbean’. The project is being implemented in eight countries in the Caribbean including Belize.

The programme is designed to build the capacity of members of various key populations to identify and address discrimination and to contribute to increased community participation in decision making in the national HIV and AIDS response.

Visit the NAC (Belize) website here.

WhatsApp as a Platform for Continued Professional Development for health workers

The Knowledge for Health project (Baltimore, Maryland) tested the WhatsApp Messenger platform as a mode to deliver family planning continued professional development training content to Kenyan health workers and promote knowledge exchange and discussion.

A seven-week training programme on healthy timing and spacing of pregnancy (HTSP) was designed and delivered to 160 participants. The findings from the training activity reveal that WhatsApp is well-received as a platform for continuing professional development. Implementation of the activity also led to a number of lessons learned around training setup, facilitation, and active participation. To read the full report click here.

WHO premieres interactive, web-based, knowledge-transfer platform

‘OpenWHO’ is WHO’s new interactive, web-based, knowledge-transfer platform offering online courses to improve the response to health emergencies. OpenWHO enables the Organization and its key partners to transfer life-saving knowledge to large numbers of frontline responders. To access click here.

Improving Youth Sexual and Reproductive Health through Digital Storytelling

Storytelling is an incredibly powerful tool for social and behaviour change. It inspires people to view a topic in a new way or motivate them to make a positive change in their lives. Traditionally, storytelling has been done through face-to-face conversations. However, increased access to mobile phones and social media has changed the way that people can share and hear stories, as well as expanded the number of people reached by one person’s story.

Please join the Health Communication Capacity Collaborative (HC3) on Wednesday, August 23 from 9:00 – 10:00 am EDT to hear about the experiences of young sexual and reproductive health (SRH) champions who have used storytelling to mobilize others around the topic. Speakers will give tips for making quality and engaging videos and positively interacting with viewers. HC3 will also launch its newly developed FP INFOcus Guide, which provides step-by-step guidance for producing and promoting mobile phone videos that give young people the information they need to make informed contraceptive choices. Representatives from HACEY Health Initiative, a Nigerian non-profit organization, will share their experiences working with HC3 to pilot the FP INFOcus Guide and approach.

Webinar speakers include:

Daysha Veronica Edewi is a writer, director, producer and social media influencer who currently works for BuzzFeed as a Video Producer. At BuzzFeed, Daysha produces viral short-form video content, with a focus on sexual health, race and gender politics and body positivity. Her videos have been featured on the Huffington Post, Bustle and Refinery29, among other media outlets.

Muluba Habanyama is a journalism student at the Sheridan College Institute of Technology and an HIV activist. She was born HIV-positive and lost both of her parents to the virus. Since disclosing her status on YouTube in December 2014, she has been featured in various Canadian publications, as well as the MTV Staying Alive Foundation. She has a passion for education, engaging and empowering youth and has served as the national ambassador for the Canadian Foundation for AIDS Research’s (CANFAR) Kisses for CANFAR project.

Cori Fordham is a Program Officer with the Health Communication Capacity Collaborative, led by the Johns Hopkins Center for Communication Programs, and has over five years’ experience in global health and social and behaviour change. She supports the FP INFOcus project and co-authored the FP INFOcus Guide. Cori is passionate about using creative and innovative strategies to give key populations the tools they need to improve their health and well-being.

Winifred Imoyera is a Program Officer with HACEY Health Initiative, with five years’ experience promoting health in several parts of southern and western Nigeria. Using the FP INFOcus approach, Winifred has developed and shared a series of mobile phone videos aimed at increasing youth’s knowledge of long-acting reversible contraceptives.

David Adewoye is an IT and Communications Manager with HACEY Health Initiative. He has collaborated on several mobile and web-based projects, including HACEY’s FP INFOcus video series, and actively promotes the use of technology in addressing health challenges.

PANCAP facilitates study tour at JASL

PANCAP facilitated a study tour for seven (7) partners at the Jamaica AIDS Support for Life (JASL) organisation in Kingston, Jamaica on August 8-11. Led by PANCAP Knowledge Coordinator, Dr Shanti Singh-Anthony, the study tour titled the ‘South-to-South Learning Exchange’, aimed to expose the partners to JASL’s model of care delivery including the antiretroviral (ART) delivery model. The activity forms part of the initiatives under the PANCAP Knowledge for Health Project (Official project web page here).

Objectives

The participants from Barbados, Guyana and The Bahamas toured JASL’s facilities and were provided with first-hand information on JASL’s operations. Dr Singh-Anthony explained, ‘the study tour focused on providing participants with a full illustration of the model of care delivery. Participants were provided with information on the factors contributing to the successful delivery of comprehensive HIV prevention, care, treatment and support services by JASL including the provision of ART to key populations’.

The study tour also aimed to illustrate for participants the degree and mechanisms of coordination and collaboration between JASL and the Ministry of Health (Jamaica) in supporting the scale up of HIV prevention, care and treatment services to key populations. In addition, the study tour facilitated knowledge sharing and exchange among participants on 90-90-90 and Treat All.

Outcomes and next steps

Dr Singh-Anthony emphasized that one of the key outcomes of the tour would be the development of country specific action plans to enhance in-country collaboration among National AIDS Programme Managers and Civil Society Organisations. ‘One of our final activities is the preparation of work plans by participants based on the knowledge and best practice steps garnered from JASL’, stated Dr Singh-Anthony, ‘our intention is that the study tour achieves actionable steps that participants can incorporate into their own models of delivery to improve health outcomes for people living with HIV’.

Capturing a best practice

The JASL Model of Care and other key operational activities will be documented and shared with the entire Partnership as well as the study tour experience. The documentation was facilitated by Ms Kathi Fox of the Knowledge for Health Project, Baltimore, Maryland. In addition, all participants will be sharing their experiences in the form of blogs which will be highlighted on the study tour web page on PANCAP.org available here.

How to promote your case studies and best practices using the PANCAP Document Library

Step 1. Click on the ‘Resources’ menu and select ‘Document Library’.

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Step 10. Complete all necessary fields to provide viewers with as much information about your document as possible. Your document will also be reviewed before it is posted. Details are important for the review.

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To upload a document now, click here.

For clarifications, please contact taustin.consultant@caricom.org

CARICOM Secretariat – PANCAP HOSTS HIV EDUTAINMENT EVENT

Tuesday, August 8, 2017 (PANCAP Coordinating Unit, CARICOM Secretariat): The Pan Caribbean Partnership against HIV and AIDS (PANCAP), the mechanism that provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, upon the initiative and request from the Office of the Deputy Secretary-General will facilitate an awareness activity on HIV and AIDS titled ‘HIV Edutainment Hangout’. The special initiative will focus on the children of CARICOM employees, ages 10 – 19 and will be held on Wednesday, August 9, 2017 at the CARICOM Secretariat, Georgetown, Guyana.

The event will be hosted by the Office of the Deputy Secretary-General in close collaboration with the PANCAP Coordinating Unit, CARICOM Secretariat. The first of its kind, the activity is meant to reinforce the message from PANCAP to increase HIV and AIDS education among youth in the region.

Director of PANCAP, Mr Dereck Springer, explained ‘we believe that education should begin at home, hence we are educating the children of CARICOM Secretariat employees on HIV and AIDS-related topics with the intention to inspire other institutions and networks within the region to conduct similar activities. PANCAP has been advocating for an increase in HIV education among youth. This was done most notably during our ‘Meeting of Youth Leaders: Sexual and Reproductive Health’ on April 21 and 22, 2017 in Port-of-Spain, Republic of Trinidad and Tobago.

Dr. Manorma Soeknandan, Deputy Secretary-General, CARICOM Secretariat, shared that the response to the initiative has been overwhelming with over 50 participants registering. The event will include a combination of education and entertainment on HIV-related topics including HIV transmission, stigma and discrimination and prevention with an overarching emphasis on how youth can contribute to the end of AIDS.

Role-play, drama and creative writing will be utilised to engage participants in scenarios, which will seek to build their capacity to recognise social situations, which may put them at risk, as well as the ability to recognise and address stigma and discrimination and identify ways in which HIV transmission can be prevented and discuss what they can do to protect themselves from HIV.

‘Youth have an integral role in ending AIDS’, stated Dr. Soeknandan, ‘we hope that this event serves as a catalyst for heightened advocacy and mobilisation of resources for HIV education among Caribbean youth’.

– ENDS –

What is PANCAP?

PANCAP is a Caribbean regional partnership of governments, regional civil society organisations, regional institutions and organisations, bilateral and multilateral agencies and contributing donor partners which was established on 14 February 2001. PANCAP provides a structured and unified approach to the Caribbean’s response to the HIV epidemic, coordinates the response through the Caribbean Regional Strategic Framework on HIV and AIDS to maximise efficient use of resources and increase impact, mobilises resources and build capacity of partners.

Contact:
Timothy Austin
Communications Specialist
PANCAP Coordinating Unit
CARICOM Secretariat
Turkeyen, Greater Georgetown, Guyana
Email: taustin.consultant@caricom.org
Tel: (592) 222-0001-75, Ext. 3409 | Visit www.PANCAP.org