Despite having taken huge steps to reduce the prevalence of HIV along with the numbers of people dying via which, many people in Malawi still get sick along with develop advanced HIV. however a fresh style of care could help communities spot the symptoms of HIV along with speed up the referral process, to ensure HIV positive patients receive care quickly along with effectively.
Around 300,000 people live in Nsanje district, in southern Malawi, on the border with Mozambique. According to government estimates, 12.5 per cent of them – around 24-25,000 people – are HIV positive. which is usually significantly higher than the national average of 9.2 per cent. Outside the only public hospital from the district there is usually a steady flow of people seeking care.
In October 2019, Austin was brought in by ambulance along with admitted to the Nsanje District Hospital. He had lost a lot of weight along with was urinating frequently. He had tested positive for HIV in 2016 along with had been receiving antiretroviral (ARV) treatment ever since. however for a three-month period, he stopped taking his medication, a decision which had immediate consequences.
“I quarrelled with my wife; I told her which would likely be better for me to die. I stopped taking my medication for three months along with soon got worse,” he remembers.
Situations like Austin’s are common. Since MSF began working in Malawi, we have noticed which people fail to maintain their ARV treatment programmes for several reasons.
“Some believe which which is usually better to go along with seek help via a traditional healer,” says Brains Kamanula, who provides psychosocial support along with mentorship at Nsanje District Hospital.
various other issues are to do with distance along with economic challenges. The nearest health facility can be far away along with the transportation to get there can be expensive. Instead of going to the hospital, many have to prioritise working to survive along with support their families.
“People also lack basic knowledge about the warning signs of HIV. Even though MSF has health promoters which go to communities to raise awareness about danger signs, we can’t reach everyone,” says Brains Kamanula. “from the end, by the time they come to the hospital, many people are already very sick.”
The circle of care style aims to reduce mortality among HIV patients through early detection along with strengthening the referral system within the circle – the community, health centre along with hospital. Jomah Kollie, medical team leader for the Nsanje project
Malawi has long struggled having a high prevalence of HIV, along with HIV/AIDS remains the most common cause of death, with an estimated 13,000 AIDS-related deaths a year. In recent years huge investments has been made by the Global Fund along with Pepfar to manage along with reduce the number of people with HIV along with to reach the UNAIDS 0-0-0 target by 2020.
which target commits a country to ensuring which 0 per cent of people living with HIV will know their HIV status, 0 per cent of people having a diagnosed HIV infection will receive sustained ARV therapy, along with 0 per cent of people receiving ARV therapy will have viral suppression.
However, lately the progress in decreasing the number of HIV-related deaths has stagnated. In an effort to improve care for people with advanced HIVThe World Health Organization defines Advanced HIV as patients having a CD4 cell count below 0 cells/mm3, or a WHO clinical stage 3 or 4, or all children under the age of all 5 at the presentation of care. in Nsanje district, MSF along with the Ministry of Health have established a fresh operating style called the ‘circle of care’.
“The circle of care style aims to reduce mortality among HIV patients through early detection along with strengthening the referral system within the circle – the community, health centre along with hospital. which is usually achieved by enabling communities to identify sick patients, ensuring efficient diagnosis along with initiation from the health centres, along with in-depth assessment along with quality care from the district hospital,” says Jomah Kollie, medical team leader for the Nsanje project.
When a patient arrives at the Nsanje District Hospital, they are brought to the rapid assessment unit where they can be quickly stabilised along with assessed. Once which is usually done, the patient can be put on the right treatment along with admitted to the ward.
“which will not happen again”
Twenty-all 5-year-old Lita is usually sitting with her parents from the shade outside the female ward at Nsanje District Hospital. For her which all started out when she wasn’t feeling well at the beginning of the year. Her family brought her to the hospital where she tested positive for HIV. Lita was advised to start taking ARV drugs. however after she was discharged, she stopped taking her medication along with, as a result, she started out to get sick again.
Lita was re-admitted to Nsanje District Hospital in October with fever, a bloated stomach along with leg swelling. which time, her father is usually determined to make sure his daughter follows her treatment programme.
“which will not happen again, as I will be around,” says her father Gerrald. “I will be there doing sure which when she is usually wakes up, I am there along with she takes her drugs. The same with the evening dose – I will make sure which before she goes to sleep, she has taken her drugs.”
A few days ago, Lita was unable to walk without support. right now she is usually feeling better, however she misses the food back home along with her three-year-old daughter. The next step for Gerrald is usually to get his granddaughter tested as well.
“I want to bring her here for testing to ensure we get to know her status – if she is usually HIV positive or negative,” he says.
Work from the community
The circle of care starts at the community level. Here, MSF community health workers work with the traditional authorities, patient groups along with local associations to reinforce existing community structures along with identify those who are sick along with need more care, while creating community awareness of symptoms along with danger signs.
“Previously, most HIV/TB activities were done at a health facility level along with not much from the communities. As a result, people who defaulted had no proper follow up,” explains Moses Luhanga, information along with education manager.
When someone is usually flagged as requiring further treatment, they are then referred to a nearby health centre. Here MSF, working with the Ministry of Health, has instituted a package of care which begins having a very quick assessment along with some tests; CrAG for cryptococcal meningitis, CD4 count along having a test of blood sugar levels along with urine. Once which is usually established which the patient features a condition requiring advanced management, they are referred to the district hospital.
Back at the hospital, Austin is usually getting ready to be discharged. He along with his wife are carefully wrapping up their belongings in chitenjes, traditional fabrics used in Malawi. After 12 days at the hospital they are happy to go home. He has been diagnosed with diabetes; like being HIV positive, which is usually a condition he must manage for the rest of his life.
To make sure Austin along with all the various other HIV positive patients being discharged stick to their treatment programmes along with don’t fall back from the circle of advanced HIV, MSF features a post-discharge procedure where counsellors will go along with visit them.
Although Nsanje district is usually close to meeting the 0-0-0 targets, the next challenge will be to make sure people on HIV medication continue their treatment along with receive quality care when falling sick. however getting people to know their status, along with start the treatment, is usually a step from the right direction.
Before the circle of care was implemented from the district, statistics via Nsanje district hospital indicated which 27 per cent of people entering the hospital with advanced HIV would likely die. however since the implementation of the system, there has been a gradual reduction from the mortality rate of hospitalised patients with advanced HIV; over the last year the mortality rate is usually under 15 per cent.
For people like Austin, getting the care he needed not only made him well, which also inspired him to make sure various other people who are HIV positive get to know their status, along with then start along with stay on the life-saving treatment.
“I want to be the voice of the change in my community. I want to find people which are suffering via HIV along with change which community to be disease-free. After being looked after, I cannot just stand here while someone is usually suffering.”