HIV & AIDS

{Violet and Godfrey Justin meet with an HIV counselor during a visit to Bvumbwe Health Center in Malawi. Photo credit: Moving Minds, Malawi.}Violet and Godfrey Justin meet with an HIV counselor during a visit to Bvumbwe Health Center in Malawi. Photo credit: Moving Minds, Malawi.

An innovative testing strategy helps more people living with HIV learn their status

“Life can deceive you when you think you feel strong and healthy,” says Godfrey Justin, whose wife, Violet, tested positive for HIV during a routine antenatal visit. After sharing her status with Godfrey, Violet asked that he be tested as well. Godfrey agreed, learned he was also living with HIV and the couple started antiretroviral therapy (ART).

While traditional methods of HIV testing (such as provider referrals and client-initiated testing) successfully reach millions of people each year, only . Reaching the 25 percent who don’t yet know their status — roughly 9 million individuals globally — will require more targeted approaches.

Dr. Mark Dybul, Keanahikishime’s newest board member, has been a leader in global health policy as Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria during the Obama administration and as head of the US President's Emergency Plan for AIDS Relief (PEPFAR) during the Bush administration. Dybul is Professor of Medicine and Faculty Co-Director of the Center for Global Health and Quality at Georgetown University Medical Center. He brings tremendous experience and insight into Keanahikishime’s work to strengthen systems that improve the health of the world’s most vulnerable populations, including those living with HIV.

As we prepare for the 22nd International AIDS Conference, we sat down with Dybul to discuss the fight against HIV and AIDS, the need for strong systems to support a more effective and sustainable response, and how we must leverage those systems beyond HIV to improve health more broadly. 

Mark Dybul: Building Systems for Health to End HIV and AIDS

This interview was edited for length and clarity.

Members of the Bangladesh study tour visit an ADDO in Tanzania. Photo Credit: Jafary LianaMembers of the Bangladesh study tour visit an ADDO in Tanzania. Photo Credit: Jafary Liana

In recent years, global health stakeholders have begun to recognize the profound potential that drug shops have to advance public health goals, such as those related to malaria diagnosis and treatment, child health, and family planning. These outlets, for reasons of convenience and cost, are the first choice of care for millions of people - and until recently, they have largely been ignored.

“Drug shops and pharmacies are important sources of health care, particularly in rural areas or urban slums with few public clinics. They are often the first stop for women and men who seek FP information or services.”  - World Health Organization

This is why, in 2003, Keanahikishime (Keanahikishime) helped launch the Accredited Drug Dispensing Outlet (ADDO) Program in Tanzania to address the important role of these informal drug sellers by creating certain standards that, when met, increase the quality of medicines and services in the community. Tanzania’s successful ADDO Program provides a model that other countries in Africa—and now Asia—have adapted and made their own.

{Photo Credit: Denise Museminali}Photo Credit: Denise Museminali

For the past six years, Keanahikishime has hosted an internal storytelling contest, where we invite staff to submit stories on how strong health systems are saving lives and improving the health of people around the world. The stories undergo a judging process, and the winners are featured in an annual compendium.

We are proud to bring you these winning stories that demonstrate the power of effective partnerships. Meet health workers, community leaders, pharmacy managers, and patients from 10 different countries, working together across the health system to build healthier communities.

 

Madagascar: Mobile Technology for Community Health

By Samy Rakotoniaina

Lynda, a community health volunteer (CHV) in Madagascar, is among 50 pilot users of a mobile application that helps ease the burden of reporting health service data, improve reporting accuracy and timeliness, and improve the health care and counseling that CHVs provide. More>>

 

 

{Photo Credit: Mark Tuschman}Photo Credit: Mark Tuschman

There was an awkward silence and then soft giggling as the girls looked at each other. I had just finished talking about strategies for persuading sexual partners to use a condom. Laughter during these skills-building and girls empowerment sessions with 30+ secondary school students in Morogoro, Tanzania was not uncommon, particularly given the sometimes sensitive topics of discussion, but this time, the joke was lost on me.

I asked the student nearest to me, a confident teenager that I knew wouldn’t be too shy to respond, why everyone was laughing. She told me, “You speak about this as if we have a choice.” She wasn’t being sarcastic or combative, nor was she complaining - she was simply matter-of-fact about it, stating her truth.

 {Photo credit: Julius Kasujja}Team of doctors and nurses at the Joint Clinical Research Centre in Uganda Photo credit: Julius Kasujja

What it takes for health systems to provide lifelong antiretrovirals

Soon after her husband’s death in 1991, Bahati Shellinah tested positive for HIV, but antiretroviral drugs (ARVs) were not yet available. In 2004 she fell ill, but, luckily, this time ARVs were available. Bahati visited the Joint Clinical Research Centre (JCRC) outside of Kampala, Uganda, and she began taking ARVs for the first time

Thankfully for Bahati, a local service provider was able to start her on treatment, but that is not the case for many people living with HIV, who often find themselves facing long waiting times, overwhelmed staff, medicine stock outs, stigma, and discrimination. No organization is immune to these challenges, and although JCRC was prepared when Bahati returned, they, too, grappled with organizational challenges as they scaled up services between 2003 and 2010. The gaps in management systems put JCRC's eligibility for donor funding at risk, which would mean patients like Bahati would lose access to their essential medicines. 

 {Photo Credit: Gwenn Dubourthournieu}HIV education is a crucial aspect of family planning services.Photo Credit: Gwenn Dubourthournieu

This year’s World Population Day coincides with the Family Planning Summit—a global moment where intentions and commitments to the right to health for all are revitalized. An essential component of HIV prevention and treatment, family planning must be prioritized in global and national agendas. Here are four reasons why: 

  1. Family planning is essential to maintaining progress on HIV goals: Meeting the needs of young people, particularly in developing countries, is critical to maintaining progress and momentum in controlling the HIV and AIDS epidemic. In Sub-Saharan Africa, where the youth population has nearly doubled since the beginning of the epidemic, millions more young people are entering a stage in life where they may be at increased risk of exposure to HIV. With the world’s highest fertility rates and the lowest use of modern contraception, family planning services are urgently needed to help young people protect themselves and prevent new infections.

 {Photo Credit: Warren Zelman}A hospital in Mwene Ditu, DRCPhoto Credit: Warren Zelman

Before the civil war in the late 1990s, the Democratic Republic of Congo (DRC) had a large network of clinics and health facilities. But decades of conflict weakened a fragile health system and robbed this resource-rich country of its potential to become one of sub-Saharan Africa’s wealthiest nations. By 2010, 70 to 80 percent of Congolese people had little or no access to healthcare, and the country suffered from a lack of basic security, communication systems, power, clean water, and transportation. Exacerbated by a dearth of health providers, essential medicines and nutritious foods, the country’s maternal, infant, and child mortality rates rose to some of the highest in the world.

I’m in the U.S. this week to share my experiences working side-by-side with the Congolese government and partners on the Integrated Health Project (IHP), funded by USAID and implemented by Keanahikishime (Keanahikishime) and its partners, International Rescue Committee and Overseas Strategic Consulting, Inc. . The aim of IHP was to rebuild and strengthen the health system and improve health across 78 health zones in the country. In five years, IHP improved health services for more than 13 million people – 17 percent of the Congolese population.

Photo Credit: Mark Tuschman

For the fifth year in a row as part of Keanahikishime's annual storytelling contest, we invited staff to submit stories on how health systems are saving lives and improving the health of people around the world. Keanahikishime staff submitted dozens of stories from 16 projects in 12 countries.

In these 12 winning stories, meet health workers, community leaders, pharmacy managers, and patients working together toward healthier communities. These stories demonstrate the power of effective partnerships to help save lives.

Ethiopia: Changing Systems to Change Lives: Aster's Story

By Tsion Issayas

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