Quality care at Area 25 Health Center in Lilongwe, Malawi, helps set the stage for an HIV-free generation
The day starts early at Area 25 Health Center in Lilongwe, Malawi. Clients begin arriving at the health facility before six in the morning to secure a good spot in the line. Staff from Tingathe, a USAID-funded program implemented by Baylor College of Medicine Children’s Foundation-Malawi, arrive at six a.m. and begin to conduct health talks with those waiting at the antiretroviral therapy (ART) clinic as well as the antenatal care (ANC) clinic. At the ART clinic, clients living with HIV learn about the importance of monitoring their viral load to ensure that the treatment is working and HIV is suppressed in their bodies. Pregnant women at the ANC clinic are informed about prevention of mother-to-child transmission (PMTCT). Tingathe staff will support the provision of HIV testing to all women attending the health facility for their first ANC visit today. After the health talks, the Tingathe staff meet in a small office to debrief on the sessions and prepare for the day ahead. Today – a Wednesday – is an ART clinic day, with large numbers of clients attending the facility to pick up their treatment. All 19 of Tingathe’s staff will remain at Area 25 Health Center today to assist. They are comprised of community health workers (CHWs) – most of them trained to test clients for HIV – as well as a site supervisor and assistant site supervisor. On other days, the CHWs conduct home visits to monitor and support their clients’ treatment adherence. The Tingathe staff disburse after the meeting to conduct various activities in the ART and ANC clinics, including doing vitals (measuring weight, height, and mid-upper-arm circumference), providing HIV testing to both adults and children, registering new clients for home visits, pulling client files, conducting adherence counselling, and distributing nutritional supplements. Pulcheria Teketa, the Assistant Site Supervisor, has been working with Tingathe for six years. She began as a CHW providing HIV counselling and testing, was promoted to senior counsellor in 2013, and advanced to her current position in 2017. Working with Tingathe has taught her a lot, she shared, particularly in terms of counselling. |
“My job is so important to me,” Pulcheria said. “I really enjoy the work and I am able to support my family because of working with Tingathe. It has taught us to work hard, and we take it seriously. If I come late, it’s the clients who suffer. I believe we are really contributing, making sure clients receive the services they need on time and providing follow-up visits at home.”
Drudoh Mwale is a CHW and counsellor with Tingathe. Today she is providing enhanced adherence counselling to clients with high viral load results, which could indicate challenges with taking their treatment consistently. “We call them ‘VIP clients,’” she said. “When the viral load results are high, a community health worker goes to the client’s home to let her know she needs to come to the clinic. We use our counselling guide to probe different issues and share strategies with them to remember to take the medication.” These strategies are tailored to each client, such as a 12-year-old boy putting his medication bottles in his school shoes to remind him to take his treatment in the morning before he leaves, and a busy mother putting them on her pillow to ensure she takes it before going to sleep.
Preventing mother-to-child transmission of HIV
Agnes[1] is 35 years old and has four children. She came to Lilongwe with her parents in 1996, where she met her husband, a builder. Her first child, Christine, is now 13 years old and is living with HIV. Agnes began taking ART when she was pregnant with her second child, who is now 10 years old and HIV-negative. Drudoh has supported Agnes at Area 25 Health Center for the past six years, helping ensure that Agnes’ two youngest children were also not infected with HIV.
The Ministry of Health’s PMTCT program, which Tingathe has supported for nearly 10 years, mitigates the transmission of HIV throughout a woman’s pregnancy, during delivery, and for two years after birth.[2] Babies are tested for HIV at six weeks, one year and two years, and then discharged from care if they remain HIV-negative. In the past 18 months, Tingathe has tested more than 140,000 pregnant women for HIV. Of those who tested HIV-positive, 98% have started ART for their own health and to help protect their babies. Of the more than 8,000 HIV-exposed babies who completed the program in the past year, 97% were HIV-free.[3]
Agnes, one of many to benefit from the program, is grateful for the support. “I am happy that the children are HIV-negative,” she said. “I know I have done my best to protect them from HIV.”
Promoting quality of life regardless of HIV status
Beyond supporting Agnes with her own treatment and helping protect her children from HIV, Tigathe has played an important role in promoting Christine’s health. Agnes was afraid to tell Christine about her HIV status, and she didn’t know how to even start the conversation. At nine years old, Christine was asking questions such as, “I am not sick and you are trying to get me to take these pills, so what is happening to me? What are these pills for?” Agnes said that Tingathe’s help made the process easy, as they assisted her to start the discussion with Christine about her HIV status when she started asking questions and supported her as she grew older. Tingathe has developed an ART flipchart which staff use as a key tool to explain HIV and its treatment in simple terms, paving the way for a child to understand his or her HIV status and to begin to take responsibility for his or her own health.
Christine is now healthy on treatment, and both she and her mother are virally suppressed. She is in grade eight in school and her favorite subjects are English, Science and Information Technology. “It makes me happy to learn,” she said. “I want to be able to communicate with international people and know about new technology.” When asked for an example, Christine shared that she is interested in meteorology – knowing the weather forecast where she lives and in other parts of the world.
Christine has a beautiful smile and expressive face. Although initially shy, she is wise and reflective when answering questions. “At first I was not happy with my HIV result when I was told,” she said. “But as time went on and I came to the clinic, I saw many other children also taking the medication and I began to accept it.” Christine also attends Tingathe’s Teen Club, an initiative to provide psychosocial and peer support to youth living with HIV. She enjoys learning about adherence and shares strategies with her friends, such as drawing a picture of a girl taking ART and hanging it up in the bedroom. Christine uses her father’s cell phone alarm as a treatment reminder. She has high hopes for the future.
“I want to be a judge to protect my country and settle disputes among the people,” Christine said. Her father is involved in community policing and dispute resolution, and her interest was strengthened by observing bias in a local criminal case. “When I become a judge,” she declared, “I want to treat all people fairly and equally, with justice.”
By accessing the care and support they need, Christine – and the entire family – are on track to lead quality lives and achieve their aspirations.
*All quotes translated from Chichewa
[1] All client names in this story are pseudonyms
[2] Babies are monitored until two years to ensure they have not been infected with HIV through breastfeeding
[3] Of the children who tested HIV-positive, 94% were started on treatment – giving them the opportunity to grow and thrive despite their positive HIV status
Drudoh Mwale is a CHW and counsellor with Tingathe. Today she is providing enhanced adherence counselling to clients with high viral load results, which could indicate challenges with taking their treatment consistently. “We call them ‘VIP clients,’” she said. “When the viral load results are high, a community health worker goes to the client’s home to let her know she needs to come to the clinic. We use our counselling guide to probe different issues and share strategies with them to remember to take the medication.” These strategies are tailored to each client, such as a 12-year-old boy putting his medication bottles in his school shoes to remind him to take his treatment in the morning before he leaves, and a busy mother putting them on her pillow to ensure she takes it before going to sleep.
Preventing mother-to-child transmission of HIV
Agnes[1] is 35 years old and has four children. She came to Lilongwe with her parents in 1996, where she met her husband, a builder. Her first child, Christine, is now 13 years old and is living with HIV. Agnes began taking ART when she was pregnant with her second child, who is now 10 years old and HIV-negative. Drudoh has supported Agnes at Area 25 Health Center for the past six years, helping ensure that Agnes’ two youngest children were also not infected with HIV.
The Ministry of Health’s PMTCT program, which Tingathe has supported for nearly 10 years, mitigates the transmission of HIV throughout a woman’s pregnancy, during delivery, and for two years after birth.[2] Babies are tested for HIV at six weeks, one year and two years, and then discharged from care if they remain HIV-negative. In the past 18 months, Tingathe has tested more than 140,000 pregnant women for HIV. Of those who tested HIV-positive, 98% have started ART for their own health and to help protect their babies. Of the more than 8,000 HIV-exposed babies who completed the program in the past year, 97% were HIV-free.[3]
Agnes, one of many to benefit from the program, is grateful for the support. “I am happy that the children are HIV-negative,” she said. “I know I have done my best to protect them from HIV.”
Promoting quality of life regardless of HIV status
Beyond supporting Agnes with her own treatment and helping protect her children from HIV, Tigathe has played an important role in promoting Christine’s health. Agnes was afraid to tell Christine about her HIV status, and she didn’t know how to even start the conversation. At nine years old, Christine was asking questions such as, “I am not sick and you are trying to get me to take these pills, so what is happening to me? What are these pills for?” Agnes said that Tingathe’s help made the process easy, as they assisted her to start the discussion with Christine about her HIV status when she started asking questions and supported her as she grew older. Tingathe has developed an ART flipchart which staff use as a key tool to explain HIV and its treatment in simple terms, paving the way for a child to understand his or her HIV status and to begin to take responsibility for his or her own health.
Christine is now healthy on treatment, and both she and her mother are virally suppressed. She is in grade eight in school and her favorite subjects are English, Science and Information Technology. “It makes me happy to learn,” she said. “I want to be able to communicate with international people and know about new technology.” When asked for an example, Christine shared that she is interested in meteorology – knowing the weather forecast where she lives and in other parts of the world.
Christine has a beautiful smile and expressive face. Although initially shy, she is wise and reflective when answering questions. “At first I was not happy with my HIV result when I was told,” she said. “But as time went on and I came to the clinic, I saw many other children also taking the medication and I began to accept it.” Christine also attends Tingathe’s Teen Club, an initiative to provide psychosocial and peer support to youth living with HIV. She enjoys learning about adherence and shares strategies with her friends, such as drawing a picture of a girl taking ART and hanging it up in the bedroom. Christine uses her father’s cell phone alarm as a treatment reminder. She has high hopes for the future.
“I want to be a judge to protect my country and settle disputes among the people,” Christine said. Her father is involved in community policing and dispute resolution, and her interest was strengthened by observing bias in a local criminal case. “When I become a judge,” she declared, “I want to treat all people fairly and equally, with justice.”
By accessing the care and support they need, Christine – and the entire family – are on track to lead quality lives and achieve their aspirations.
*All quotes translated from Chichewa
[1] All client names in this story are pseudonyms
[2] Babies are monitored until two years to ensure they have not been infected with HIV through breastfeeding
[3] Of the children who tested HIV-positive, 94% were started on treatment – giving them the opportunity to grow and thrive despite their positive HIV status
Baylor-Malawi: Supporting the national HIV response and achievement of the UNAIDS 90-90-90 targets
Tingathe (“Together, we can”) is supporting 66 health facilities in four high-prevalence districts through the USAID-funded Innovative HIV Services for Malawi program. Through this program, Tingathe is supporting the delivery of high-quality comprehensive HIV services to help Malawi achieve the UNAIDS 90-90-90 targets for HIV status knowledge, treatment, and viral suppression among people living with HIV.
Tingathe has been supporting Area 25 Health Center for eight years. The ART clinic, which was constructed with USAID funding, was officially opened in 2014. Tingathe also supports the health facility by providing clinical mentorship, systems strengthening, and psychosocial services. Clinical mentors work hand-in-hand with the full-time staff and monitor overall service provision to promote system strengthening at the facility.
Tingathe (“Together, we can”) is supporting 66 health facilities in four high-prevalence districts through the USAID-funded Innovative HIV Services for Malawi program. Through this program, Tingathe is supporting the delivery of high-quality comprehensive HIV services to help Malawi achieve the UNAIDS 90-90-90 targets for HIV status knowledge, treatment, and viral suppression among people living with HIV.
Tingathe has been supporting Area 25 Health Center for eight years. The ART clinic, which was constructed with USAID funding, was officially opened in 2014. Tingathe also supports the health facility by providing clinical mentorship, systems strengthening, and psychosocial services. Clinical mentors work hand-in-hand with the full-time staff and monitor overall service provision to promote system strengthening at the facility.