UPEC Service Unit
There has always been a global effort to fight against diseases that affect people around the world, with HIV/AIDS currently amongst the top diseases. This effort is often translated to National and local levels which remain the functional unit.The UNAIDS 95 95 95 is the next ambitious goal of achieving Epidemic control for HIV by 2030 after most countries including Cameroon failed
to achieve the 90 90 90 targets in 2020. The country is however committed to ensuring that the trend in HIV infections is reversed. As noted in the above-stated article, stronger health systems are necessary for achieving these goals.
These, therefore, have led to various partnerships intended to achieving epidemic control of the HIV pandemic while improving the quality of life of HIV-infected patients. One of the main partners in Cameroon is the President’s Emergency Plan For AIDS Relief (PEPFAR) which is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. The activities of PEPFAR in Cameroon is carried out by implementing partners
across the country supervised by CDC Atlanta. In Cameroon, there are four implementing partners working in four Zones, with the HIV Free Project of the Cameroon Baptist Convention Health Services (CBCHS) working in Zone 1, covering the North West, South West, and West Regions of the country. The activities of the HIV Free Project in the South West Region are currently being implemented through the Direct Service Delivery (DSD) system which requires the project to add some technical staff who work in the facilities in collaboration with the staff on the ground. The DSD system officially began at the Buea Regional Hospital in October 2019, with the Project bringing in a team of 20 staff headed by the Site Project Manager, Dr. SAM Denise. The Team consisted of three nurses, one QI officer, five case managers, two testing counselors, three Index testers, and four data clerks, and a finance clerk. The team came to compliment the hard-working staff who were already taking care of over 2500
patients on ART. Intalling the team For over 15 months of activities, there has been an increase in several indicators as well as the quality of life of the patients in care.
- Case Identification :
There is been an increase in new cases of HIV cases identified from about 1-3 cases per week in October 2019 to about 5-7 cases at the end of 2020. This has been through the use of effective high yielding testing strategies like Index testing, and fully implementing the screening tool at the OPD. Index testing
has been useful in identifying some children and partners of clients on treatment. Other strategies like moonlight testing have been used. This involves testing during night hours, targeting Sex workers and their clients. This has been useful in identifying positive cases while promoting prevention by distributing condoms and lubricants. - Linkage to treatment:
The Buea Regional Hospital began the Linkage Case Management Model two months after the arrival of the project. Three Expert clients, recruited by the Hospital but paid by the project have been instrumental in working with newly identified HIV patients. Helping them accept their status and begin ARVs. The work of the testing counselors and the experience of the Social workers and Nurses have been helpful in counseling newly diagnosed
cases. The Hospital currently mentors about 8 health facilities around them, in initiating newly identified positive cases. There are on- call linkage agents ready to initiate newly diagnosed cases after regular working hours and on weekends. All these activities have increased the linkage to care from about 80% to currently between 96-100%. - Retention in Care:
Keeping the patients on treatment is very helpful in helping them achieve viral suppression. There have been great achievements in educating patients and counseling those with challenges to adherences to remain in Care. The combined efforts of the Psychosocial Agents, Case Managers, Nurses, and Doctors can be seen in the retention of clients in care. Even with the sociopolitical challenges and the COVID 19 crises which led to a drop in hospital visits, the retention has still been maintained at a high level. This has led to a growth of patients on treatment at the facility from about 2500 to about 2860 patients on treatment in care. We have used differentiated models of care to ensure patients from hard to reach localities still get their medication. Counseling is offered for all clients who default treatment and are brought back to care. Activities targeting the various age groups were have been ongoing with the last key activity being the Parents- Guardian forum chaired by the Director himself. - Viral suppression:The ultimate goal of ARVs is for the patient to achieve a suppressed and better still an undetectable viral load. This is a combination of clinical follow-up and good supply chain management to ensure clients get the required ARVs without problems of stockout. There has been a systematic follow up of clients on ARVs,
including screening and management of HIV Advance disease, with some special cases managed by the Internists. There is
proper enhanced adherence counseling for patients with unsuppressed viral load following the capacity building of the staff
in managing unsuppressed viral load. All this has a suppression rate of patients in the care of about 90%, which is one of the
best in the Region. This result however is not reflected among the pediatric age group which stands at about 70% suppression
rate. Efforts are being made to ensure the results are improved upon. - Others :
There has been significant improvement in the screening, diagnosis, and, management
of HIV Advance disease. With the help of the Administration, the acquisition of reagents for Serum Cryptococcal antigen
(CrAg), and TB LAM has been a great boost to early identification and treatment of patients with these diseases. Several
Advance disease cases have admitted and treated in the Internal Medicine Unit of the Hospital, reducing HIV-associated mortality. More than 20 HIV/TB cases have been treated. All HIV-positive patients since the onset of the DSD activities who screen negative have been placed on Isoniazid preventive therapy (IPT), to prevent new HIV/TB cases. PMTCT activities are also being carried out notably the Cohort monitoring which involves clinical and biological follow up of HIV infected mothers and their exposed infants up to 24 months after birth. This is to ensure prevention of transmission during and after the
pregnancy while ensuring rapid initiation of children diagnosed with HIV. Documentation has also been greatly improved at the treatment center given the activities of the data staff. After ensuring adequate data entry daily, there is a weekly data triangulation and quarterly Data Quality assessment. The validity and integrity of the data are assured therefore ensuring that data gotten from tools at the center are an exact representation of the activities carried out.
In summary, the collaboration between the Buea Regional Hospital and the HIV Free project has
resulted in better outcomes for the patients. Some of the factors enhancing the achievements
include:
• Commitment from the Hospital Administration. The will to see improvements across the
various activities of the hospital is essential as this creates the readiness to accept new
ideas to improve care while reducing the bureaucratic challenges that may limit the
implementation of new strategies.
• The readiness of the technical team to improve the health of patients. The efforts put in
by the various technical staff including the Specialists, Laboratory Scientists, Nurses, and
other technical staff have been very helpful. HIV activities have been properly integrated
into the various services like the Laboratory, where all the biological monitoring of our
clients are done, the OPD, and inpatient units of the hospital.
• Other partners. The activities of the project are boosted by other technical partners also
involved in HIV care and treatment. These include partners like FHI 360, CRS, Reach out,
and HIRASSO. The combined efforts have greatly improved patient care and treatment.
Like the African adage says, “one hand can not tie a bundle” partnerships are very essential
in achieving health goals at all levels.