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URC Completes Health Systems Strengthening Project in Nigerian States
Nigeria’s weak health systems, inadequate health care infrastructure and limited outreach impede efforts to care for the more than 3 million Nigerians living with HIV/AIDS and to prevent more infections. In partial response, the US Centers for Disease Control and Prevention asked URC to provide technical assistance to support health ministry efforts in two states: Enugu, starting in 2008, and Ebonyi, starting in 2011. Combined, these states have seven districts, of which five were targeted, covering 55 public and private health facilities. The initiative sought to expand access to HIV prevention, care and treatment services and to improve those services—as well as services for TB—in the targeted facilities.
The five-year HIV/AIDS Comprehensive Care Initiative (HACCI) project closed last year, and its activities and results are summarized here.
Through a quality improvement (QI) approach, HACCI worked with health care workers and others at multiple levels of the health care systems in both states. The objective was effective, efficient, client-centered and accessible services; the guiding principle was compliance with clinical standards; and the method was teamwork.
A critical early step was redesigning and renovating laboratories at five facilities. As part of these renovations, the project procured and installed essential equipment and provided training on its use. These activities expanded laboratory diagnostic capacity to ensure early access to and scale-up of treatment and care for adults, adolescents and children. Also, facility staff received hands-on training and ongoing mentoring in clinical care, QI methods and use of data for decision making. URC meanwhile engaged state health agencies, local government agencies and health facility staff to collaborate to solve common problems. A fourth step engaged community-based organizations so the communities surrounding the targeted facilities would support the government’s care/prevention efforts.
To boost services to prevent HIV transmission from mother to child, URC worked on three fronts: providing relevant in-service training to workers offering such prevention services, coordinating with the state health ministries on supportive supervision and reaching out to pregnant and lactating women and their partners, especially through HIV testing and counseling services. The initiative also strengthened referral systems between peripheral testing and comprehensive care sites and mobilized public education and advocacy at the community level.
HACCI’s orphans and vulnerable children (OVC) program helped ensure that these children receive appropriate care and support. The program worked with the state governments and trained community volunteers to identify and assess OVCs. HACCI then provided, as appropriate and necessary, direct support for protection, psychosocial care, health care and nutrition and education. Referrals connected vulnerable children to shelter, care, and economic strengthening activities.
To improve TB detection and treatment for people with HIV, HACCI worked with the states to improve and scale-up high-quality treatment and to expand detection of TB/HIV co-infection cases. The project worked to strengthen the lines of referral between TB testing points in peripheral health centers and treatment clinics in comprehensive sites. It also engaged community volunteers to reach out to TB patients who had lapsed in their treatment and identify presumed TB cases.
HACCI organized rallies in three rural Enugu districts on World TB Day 2013 to raise awareness of the disease and its symptoms. Vehicles with public address systems visited 46 villages airing TB messages that included information on symptoms to look for. Those with such symptoms were urged to visit a HACCI supported health facility for diagnosis and treatment. HACCI staff distributed 1,250 Stop TB flyers while community volunteers distributed flyers (in English and Igbo) with information on TB symptoms and HACCI supported TB facilities. They also distributed referral forms for people with TB symptoms. The rallies reached about 100,000 people and referred 400 who may have had TB to HACCI supported TB sites.
Community- and facility-based efforts to bring in more people for HIV counseling and testing substantially raised the number of people accepting these services (see Figure 1).
The results of efforts to ensure that pregnant women knew their HIV status are also impressive (Figure 2). Having this awareness-raising process in facilities’ antenatal care services system will ensure that women and their newborns who need HIV care and treatment will receive it.
Other project results include:
- HACCI’s large-scale laboratory improvement efforts enabled the expansion of HIV care and treatment services, while at the same time building the capacity of laboratories to provide reliable and timely results for improved clinical decision making. These investments not only benefitted HIV-affected patients, but a wide array of other patients, as many of the tests the labs can now conduct are also critical to managing other conditions.
- HACCI trained community volunteers enrolled more than 700 children in the OVC program and provided direct support and referrals according to the children’s needs. At the beginning of each school year, OVCs received kits of basic healthcare items, school uniforms, books, supplies and other items.
- More facilities are providing TB treatment to HIV-infected individuals (diagnosed or presumed): up from 4 facilities to 22.
January 27, 2014