Providing integrated health care at Area 18 Health Center in Lilongwe, Malawi
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Malawi has made important strides in addressing its HIV epidemic: the country has adopted universal treatment for all people living with HIV and has aligned its National Strategic Plan for HIV and AIDS to the UNAIDS 90-90-90 targets for HIV status knowledge, treatment and viral suppression.[1] New HIV infections have decreased by 46% and AIDS-related deaths have decreased by 39% since 2010.[2] However, much remains to be done, with only 66% of people living with HIV accessing antiretroviral therapy (ART), 59% of those on ART achieving viral suppression, and an estimated 4,300 new HIV infections among infants due to mother-to-child transmission.[3]
Baylor College of Medicine Children’s Foundation-Malawi is implementing the Tingathe program, supporting 63 health facilities in four high-prevalence districts through the USAID-funded Innovative HIV Services for Malawi program under the EQUIP mechanism. |
Tingathe staff at Area 18 Health Center in Lilongwe, Malawi
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Through this program, Tingathe is supporting the delivery of high-quality comprehensive HIV services to help Malawi achieve the 90-90-90 targets. Tingathe’s package of support is comprised of five interrelated components:
The Area 18 Health Center in Lilongwe, the capital of Malawi, serves a catchment area of more than 200,000 people. It provides primary health care and has specific units for antenatal care and maternity, services to children under five years old, nutrition, family planning, and communicable diseases including HIV and turberculosis. There are approximately 7,000 people living with HIV accessing ART at Area 18 Health Center, who are served by six nurses and a clinician.
Tingathe has provided 13 staff to support Area 18 Health Center, including six counsellors, six community health workers (CHWs), and one data clerk. Site supervisor Mercy Nyirenda coordinates the Tingathe team, conducting weekly meetings to assess progress and strengthen their approaches. Mercy, who is 34 years old, became a CHW with Tingathe in 2009. “I was interested in helping the community,” she said. “I saw how children born with HIV were suffering and felt compelled to help. I felt that I could contribute something to their lives and make sure that young children are born HIV-negative.” Now Mercy is completing a Bachelor of Science in Community Development to improve her knowledge and skills. “I am so happy when a client is discharged at two years old being HIV-negative,” she shared, “as well as when children are thriving on treatment.”
Successful approaches that Tingathe applies to increase HIV case finding and treatment initiation and adherence include:
Mercy envisions further progress and a brighter future at Area 18 Health Center: “I would like to see us continuing to discharge children who are HIV-negative, supporting those who are HIV-positive to live a good life, and keep increasing case findings of those living with HIV.” Collaboration among various stakeholders, such as that of Tingathe and the public health facilities it supports, is key to the country’s ultimate achievement of an AIDS-free generation.
[1] UNAIDS. Available at: http://www.unaids.org/en/regionscountries/countries/malawi
[2] Ibid.
[3] Ibid.
- Efficient health facility systems
- Quality service delivery
- Staffing
- Infrastructure
- Monitoring and evaluation and operational research
The Area 18 Health Center in Lilongwe, the capital of Malawi, serves a catchment area of more than 200,000 people. It provides primary health care and has specific units for antenatal care and maternity, services to children under five years old, nutrition, family planning, and communicable diseases including HIV and turberculosis. There are approximately 7,000 people living with HIV accessing ART at Area 18 Health Center, who are served by six nurses and a clinician.
Tingathe has provided 13 staff to support Area 18 Health Center, including six counsellors, six community health workers (CHWs), and one data clerk. Site supervisor Mercy Nyirenda coordinates the Tingathe team, conducting weekly meetings to assess progress and strengthen their approaches. Mercy, who is 34 years old, became a CHW with Tingathe in 2009. “I was interested in helping the community,” she said. “I saw how children born with HIV were suffering and felt compelled to help. I felt that I could contribute something to their lives and make sure that young children are born HIV-negative.” Now Mercy is completing a Bachelor of Science in Community Development to improve her knowledge and skills. “I am so happy when a client is discharged at two years old being HIV-negative,” she shared, “as well as when children are thriving on treatment.”
Successful approaches that Tingathe applies to increase HIV case finding and treatment initiation and adherence include:
- Strong case management: Each CHW is assigned specific clients (HIV-positive pregnant women accessing antenatal care and HIV-positive adults and children on ART) and monitors each step of the care and treatment process. This includes providing education and psychosocial support, monitoring adherence, ensuring dried blood spot testing is conducted when the infant is six weeks old and provision of appropriate follow-up care, promoting HIV testing of the client’s partner/s and other children, and arranging home testing if needed. Each CHW has a bicycle to reduce transportation time to the health facility and for home visits.
- Daily tracking of client attendance: The site supervisor oversees client attendance at the health facility’s antenatal care unit and pediatric and adult ART units by monitoring an appointment masterlist, a system developed by Tingathe. CHWs follow up clients who have missed appointments to reduce loss to follow up.
- Provider-initiated testing and counselling (PITC): This approach has been adopted by the Ministry of Health to ensure that HIV testing is integrated into routine care at health facilities. Tingathe staff aim to screen all children accessing the health facility, regardless of which unit they attend, from the under-five clinic, to the out-patient department, to the nutrition unit. Tingathe staff check for documentation of HIV testing in each child’s health passport and encourage testing for those who do not know their status.
- Index case testing and monitoring: Tingathe staff use an index client register to facilitate follow-up of their clients’ partners and children. Tingathe staff provide clients with a referral form to bring family members to the health facility for testing, or arrange to provide home testing.
- Viral load monitoring: Tingathe supports the collection of blood samples for viral load testing after the first six months of ART to monitor treatment response. If the viral load is still high, Tingathe provides intensive adherence support and the test is repeated after three months. If the viral load is low, the test is typically repeated every two years.
- Responsive programming: Site supervisors hold weekly meetings with their teams and meet together on a monthly basis to review the program’s data, learn from each other, and refine their approaches.
Mercy envisions further progress and a brighter future at Area 18 Health Center: “I would like to see us continuing to discharge children who are HIV-negative, supporting those who are HIV-positive to live a good life, and keep increasing case findings of those living with HIV.” Collaboration among various stakeholders, such as that of Tingathe and the public health facilities it supports, is key to the country’s ultimate achievement of an AIDS-free generation.
[1] UNAIDS. Available at: http://www.unaids.org/en/regionscountries/countries/malawi
[2] Ibid.
[3] Ibid.
