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AIDS CARE AND PREVENTION

(...More than Conquerors...)
Romans 8:37

The HIV and AIDS work of the Cameroon Baptist Convention Health Board is made up of the following components:

  1. AWARE HIV & AIDS/Reproductive Health
Click here for the interrelationship between the components

ACP Annual Reports

Click on the links below to download

  1. 2008 Annual Report
  2. 2007 Annual Report
Prof Tih Pius Muffih, MPH, PhD,.
Program Director
Drs Tom and Edie Welty
Drs Tom and Edie Welty
Associate Directors CBC Health Board
AIDS Care and Prevention Program

INTRODUCTION

In 1999, the Cameroon Baptist Convention Health Board (CBCHB) started a Community HIV and AIDS Education Program in response to the rising HIV and AIDS pandemic. In February 2000, the US-based Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) granted the CBCHB start-up funds to begin the Prevention of Mother to Child Transmission of HIV (PMTCT) program. Despite a small beginning, the program has become the leading
PMTCT program in Cameroon and in the Central African sub-region. From 2000 through September 2008, the program counseled 318,633 pregnant women in PMTCT and expanded PMTCT services from 2 to 401 health facilities in 6 of Cameroon’s 10 provinces. The prevalence rate of HIV decreased from 10.7% to 6.2%. Although lower than those in other African countries like South Africa, this prevalence rate still ranks among the highest in the world. That is why the CBCHB has extended the fight against HIV to incorporate a comprehensive AIDS Care and Prevention Program (ACP) – which focuses on Primary Prevention, Prevention of unintended pregnancies, Prevention of infection from infected mothers to their infants, and treatment and care to those living with HIV and their families. Go back to top

Community AIDS Education Program

Initially, the CBCHB trained and was using very few nurses for the program. But as the program kept growing, volunteer AIDS educators were recruited to provide HIV and AIDS education in schools, churches and other public settings in various communities, especially where they are familiar with cultural practices and other community-specific issues that put people at risk of contracting the disease. The CBCHB has developed a reference manual for both initial training and continued use by these Community AIDS Educators (CAEs), who have already imparted over 2 million people with factual information on HIV and AIDS. Through this program, the Board was able to notice that the HIV prevalence rate among pregnant women below age 20 decreased significantly (0.25% per year) from 2000 to 2003 in 5 CBCHB facilities. This drop could be attributed to primary prevention.

The Community AIDS Education Program

  • Disseminates basic information on HIV and AIDS, and prevention methods;
  • Advocates behaviour change as appropriate to reduce exposure to the disease;
  • Prepares and distributes educational material on HIV & AIDS;
  • Trains and certifies health educators and volunteers;
  • Sensitizes people through lectures, role-plays, videos, etc.
The program is funded by the CBCHB and Bread for the World.

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PMTCT Services

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), which granted the initial funds for the PMTCT program in February 2000 has renewed, and keeps increasing its grants to the CBCHB each year, to help scale up PMTCT activities to cover all of Cameroon. The CBCHB also works in collaboration with Cameroon’s Ministry of Public Health in the fight against this pandemic in the country. The CBCHB has fully integrated its PMTCT services into Maternal Child Health Services. Counselors and midwives provide group-facilitated counseling during first antenatal visits, giving pregnant women details on the use and availability of antiretroviral drugs. After the group-facilitated counseling, the women are received individually by the counselors with some tests proposed to them, which they can refuse or accept. This is the opt-out approach, which the CBCHB has been using for over the years to enlist women into the PMTCT program. Since 2000, some 94% of women annually accept testing for HIV. The CBCHB also supports PMTCT services in institutions run by other denominations, NGOs, industrial and government facilities by offering expert training to their staff, supplying ARVs and test kits, and supervision. The Board also monitors and evaluates the programs on regular bases.

The CBCHB has devised various means of reaching remote villages with PMTCT services. Most innovative among these methods is the use of Trained Birth Attendants (TBAs) to offer PMTCT services at the community level. In 2002, the Board’s Life Abundant Primary Health Care Program trained four birth attendants to provide PMTCT services in some remote villages. The CBCHB has successfully implemented HIV screening during many village Antenatal Clinics (ANCs) using a rapid test called Oraquick as first test, and then referring the client to the nearest integrated Health centre for a confirmatory test. By June 2005, 30 TBAs in 20 villages had counseled 2,331 women, tested 2,310 (99.1%) with 82 (3.5%) testing HIV positive. 42 of these mothers were delivered by the TBAs, with 88.1% of mothers and 85.7% of newborns receiving Nevirapine. NVP-treated babies were tested at the age of 15 months and only 2 out of 13 HIV-exposed infants tested positive in the rapid HIV antibody test. By October 2007, PMTCT services were already effective in 29 villages using 40 TBAs, and 9 field supervisors. At the end of 2007, a total of 4,040 women had been tested with 155 (3.8%) of them testing HIV positive. All the women tested positive have been led to form psycho-social support groups in their various villages. This has significantly abated stigma and discrimination on people living with the disease. Results of PMTCT services in the CBCHB yielded by TBAs are published in the Journal of Midwifery and Women’s Health USA and on internet at www.jmwh.org.

In 2003 the CBCHB PMTCT program received an International Leadership Award from EGPAF, which enabled the Board to train leaders and service providers from all over Cameroon and some West African countries as PMTCT trainers. As of July 2007, the CBCHB was supporting PMTCT services in 352 facilities, and had tested close to 250,000 pregnant women for HIV. The CBCHB is currently partnering with Ivory Coast, Zambia, and South Africa in a PMTCT Effectiveness Evaluation to determine how well the services reach its target population. The study will determine whether the pregnant women actually take their nevirapine in labor or not, the impact of PMTCT on childhood HIV-free survival, and the cost effectiveness of PMTCT services.

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Tuberculosis (TB) Control Program

The CBCHB started a TB Control Program in 1999 in response to the rapid spread of the epidemic. Because HIV infection makes people more susceptible to TB, it has been noticed that over 60% of TB patients treated at CBCHB facilities are HIV positive. Under the supervision of CBCHB doctors trained in TB management, the 3 nurses assigned to this program accept referrals from other healthcare workers, prescribe TB medications as outlined in CBCHB’s TB Manual, see returning patients, and provide tracking and follow-up care to patients. From 1999-2004, some 1,465 patients were diagnosed with TB at Banso Baptist Hospital. Of these, 66 % completed their treatment, 22 % died, and 13 % were lost to follow up. Go back to top

The Chosen Children Program (CCP) (Orphan Care)

Using an initial grant from the US-based Firelight Foundation, the CBCHB started an orphan care program in 2001 called Chosen Children Program (CCP). The CCP has received subsequent funding from the North American Baptist Conference (NAB), the Baptist General Conference (BGC), the Cameroon government, and private individuals. The CCP identifies and registers AIDS orphans and other vulnerable children and supports them through their foster parents by subsidizing their education, feeding and health care. The program also raises awareness in communities on the role of foster parents in meeting the needs of chosen children (orphans) and the importance of protecting their legal rights. The CCP has identified over 3000 orphans and supported over 800. The name of the program and the method of giving support to families were determined with input from the first group of family caregivers that were selected and trained. The Chosen Children Program

  • Identifies and registers orphans, especially AIDS orphans. 
  • Raises funds to support these children through their foster parents.
  • Trains foster parents or caregivers on basic care-giving skills and the legal rights of orphans.
  • Helps caregivers obtain micro loans for businesses.
Encourages communities to assist in caring for orphans.

Downloads

  1. Mid year report - June 2009
  2. 2008 CCP Report

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Support Groups

These are HIV infected people who come together to share experiences and receive training to empower themselves on living positively with the disease. The CBCHB runs support groups for both women and men, which usually meet separately although few of them are mixed. Today, over 70 support groups exist with a membership of over 3,000,  most of them being self-supporting, with the Board  helping to meet the medical, psychosocial and spiritual needs of members. Support groups:

  • Receive training on improved adult nutrition (including demonstration on practical food preparation), and the safest infant feeding options.
  • Encourage members to form work groups and receive loans from WINHEEDCAM for small business enterprises to generate income. Some groups manufacture and sell powder complementary foods from ground maize, Soya beans or groundnuts, and commercial infant formula, to be used for preparing porridge for 6-24 month old babies.
  • Receive training on handicraft and other marketable skills.
  • Provide a strong infrastructure for political activism.
  • Receive education on health promotion and disease prevention, including family planning and referrals for family planning services.
Assist in medical follow-up for members and their infants, including the provision of adult and infant cotrimoxazole prophylaxis, multivitamins, family planning accessories, condoms for the sexually active, periodic CD4 counts, and referral for antiretroviral therapy.

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MTCT- Plus Program

Started in 2004 with a grant from Columbia University in New York City, USA, the Mother To Child Transmission – Plus (MTCT-Plus) program was initially a demonstration project to provide care to some 750 HIV-positive persons and their infected partners and children, including pregnant women, through the Prevention of Mother To Child Transmission (PMTCT) Program. Additional funding from Columbia enables MTCT-Plus to:

  • Provide medical follow up for an increasing number of HIV positive pregnant women and their families, including regularly scheduled CD4 counts and other tests and lifelong antiretroviral therapy (ART) when indicated
  • Rapidly expand to five clinical sites: Banso and Mbingo Baptist Hospitals and Nkwen (Bamenda), Mutengene, and Mboppi (Douala) Baptist Health Centers.
Provide a more effective PMTCT drug regimen in MTCT Plus facilities; using 3 antiretroviral drugs to reduce MTCT to less than 5%.

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Youth Network for Health (YNH)

  • Encourages youth to create or join health clubs and pledge abstinence from sex and substance abuse, with the aim of preventing HIV, other sexually transmitted infections and unwanted pregnancies, and preserving the intimacy of sex as part of marriage. Information on other prevention methods is provided.
  • Carries out surveys on youths on their sexual awareness, attitudes and practices.
  • Offers free HIV tests to youths with permission from their parents, as well as HIV and AIDS education besides other programs to promote youth abstinence clubs.
  • Provides information on other health issues, especially prevention tips to youths.
YNH is funded by the CBCHB and EGPAF. Go back to top

Adopt a Health Care Worker (HCW) Program

  • Provides infected HCWs who meet treatment criteria with free ART.
  • Encourages them to form support groups.
  • Supported by donations from CBCHB employees, the US-based Christian organisation Global Strategies, the MTCT-Plus Program and well wishers.

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Extended Forum for Care (Contact Tracing)

Few contact tracing/partner notification programs on sexually transmitted infections (STI) exist in Africa. Also, there are very limited affordable tests to accurately diagnose most STIs. When donated HIV tests became available to test youth in abstinence clubs, the CBCHB tested 1,406 young people aged 12 to 26 years and found 22 out of the 984 girls (2%) and 1 out of the 422 boys (0.2%), HIV positive (p<0.01). In response to this prevalence rate, the CBCHB initiated this pioneer pilot program to determine:

  • Risk factors for HIV infection among adolescents and young adults in the North-West Province of Cameroon;
  • The acceptability and feasibility of partner notification among HIV positive individuals in Cameroon;
  • How many undiagnosed HIV cases are identified through partner notification;
  • Whether high risk male transmitters contribute to the spread of HIV among the youth, and if so, what can be done to reduce transmission;
Whether contact tracing can benefit the contacts by successfully referring them for appropriate medical evaluation and care.

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Cervical Cancer Prevention Program

Cervical cancer is the 2nd most common cancer in women worldwide, and the leading cause of cancer deaths in women in developing countries. 80 % of the 400,000 cancer cervical cases diagnosed worldwide annually are in developing countries. Most women who die from this disease are in their 30s and 40s. Cervical cancer has become rare in the US, due to decades of Pap smear screening and treatment of pre-cancers. In developing countries however, there are still some 1.7 million cases of cervical cancer and 5-13 million cases of pre-cancer. In 2007, the CBCHB entered into a partnership with the University of Alabama’s Cervical Health Program in Zambia, which is pioneering a new cervical cancer screening method. The program uses digital photo-cervicography instead of Pap smears (which are neither available nor affordable for most African women). Although no funds are available for the program in Cameroon, the Zambian program has provided training both on site and in Zambia for Health Board staff. This is the first African transcontinental internet consultation service for difficult cases. The Cameroon Baptist Convention Health Board (CBCHB) also collaborates with the Cameroonian National Fight Against Cancer in program planning and patient referral. The Board now has a mobile cervical cancer screening clinic. The clinic is run in a large US Army-donated ambulance and travels to various Health Board institutions and Support Group meetings. The team in the mobile clinic always gives priority to the screening of HIV-positive women, because they are considered at the highest risk. The CBCHB is developing expertise in cryotherapy and the loop electrical excision procedure (LEEP) to treat pre-cancers and plan training in radical surgery techniques and cancer staging. Go back to top or Click here to learn more >>

Palliative Care

In Africa, patients with prolonged pain from AIDS, cancer, and other conditions seldom have access to adequate pain management techniques to relieve their suffering. Within 3 years, the CBCHB recorded more than 800 AIDS patients on antiretroviral therapy at Banso Baptist Hospital (BBH) alone. This raised the Board’s concern to establish a palliative care program. In 2005, the CBCHB partnered with, and received training from Hospice Africa, a United Kingdom-funded palliative care program in Uganda, to begin a hospital and home-based program using modern pain management techniques and medications, including oral morphine. The program, being the first of its kind in Cameroon, started at BBH; but today, the coordinator visits some major hospitals of the Board when his services are needed. Hospice Africa assisted the Board in negotiating with the Ministry of Public Health for the program to be established in Cameroon, and to develop WHO-compatible guidelines and assurance of accountability in the use of opioids. The International Narcotics Control Board (INCB) ensures that countries comply with the Single Convention on Narcotic Drugs, (a 1961 treaty, amended in the 1972 protocol) to ensure the availability of opioids for medical use while preventing any abuse. The specific objectives of this program are to:

  • Control pain and manage symptoms related to HIV and AIDS, cancer, and other painful illness.
  • Provide psychosocial support to patients and their families at places most suitable for them (both in hospitals and clinics, and during home visits).
  • Provide spiritual support to the patients and their families as part of the holistic approach to bring them to peace within their own beliefs, before the end of life.
  • Conduct ongoing training for health professionals and community care volunteers.
  • Begin a Palliative Care Association initially within the CBC Health Board.
The pilot program has been extremely successful, as it enrolled 57 patients in its first 6 months of existence. The 2011 strategic plan of the program is to expand the program to reach at least 1600 patients in three CBCHB institutions, one other faith-based health establishment and one government health facility, if funding is available.

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CBCHB/AWARE/USAID Partnership

In 2004, the United States Agency for International Development (USAID) chose the Cameroon Baptist Convention Health Board (CBCHB) to be the Action for West Africa Region (AWARE) Regional Training Centre. This choice was based on the selection of the CBCHB as “best and promising practice” in PMTCT. The CBCHB PMTCT Program had distinguished itself in West and Central Africa by its unique, grassroots, “bottom-up” approach, its impressive program uptake by pregnant women using the opt out approach, and the rapid expansion of its services. With EGPAF funding, the CBCHB started PMTCT services in February 2000 in 2 health facilities. By December 2003, the PMTCT was supporting 92 facilities and had screened over 38,000 pregnant women for HIV. AWARE felt that these accomplishments were sufficient to qualify the CBCHB at the time to train health care providers throughout West Africa in PMTCT and reproductive health. AWARE’s support promoted the expansion of PMTCT and obstetric programs in West Africa. This was done through capacity building of decision-makers, managers, and other health care providers to enable them effectively implement PMTCT among in the 18 countries hosting AWARE projects in the world. AWARE’s strategies were to:

  • Strengthen the institutional capacity of the CBCHB.
  • Develop capacity.
  • Strengthen CBCHB’s role as a regional training center and technical resource.
  • Work towards the sustainability of the role of CBCHB activities in the region when AWARE faced out.

AWARE reproductive health’s contract with the CBCHB was to improve the Board’s obstetric care, providing technical upgrades and equipment (e.g. ultrasound machines, CD4 counters) at practicum sites to facilitate hands-on learning, training providers in family planning, and providing a wide range of contraceptive methods. Skills transferred from AWARE Reproductive Health included the Men as Partners (MAP) Program which encourages men to voluntarily test for HIV foster healthy family relationships; Client-oriented, Provider Efficient services (COPE), infection prevention, facilitative supervision, monitoring and evaluation, marketing, etc.

The impact of AWARE’s support on CBCHB services, the community, the country, and the Central and West African regions at large, is enormous. The above initiatives have been fully integrated into the management system of every CBCHB institution; and this will stay on even long after AWARE is gone. Staffs are better motivated, especially as they use COPE and facilitative supervision tools to identify and solve day to day service problems. In its first 3 years, CBCHB/AWARE trained 123 health care providers from 15 African countries in PMTCT services.

Go back to top or Click here to learn more>>

Interrelation between the components

The Youth Network for Health and the Community AIDS Education Programs both work to reduce the rate of new HIV infection, and bolster PMTCT counseling by increasing people’s knowledge on HIV thereby reducing stigma, encouraging behavior change (primary prevention), and encouraging acceptance of HIV testing.
PMTCT counselors, the women they counsel, and Support Group members in turn, become unofficial but effective Community AIDS Educators. Some Support Group members have been trained and hired as PMTCT counselors.
The Men as Partners Program encourages partners of pregnant women to be tested, and promotes healthy family relationships to reduce gender inequality and domestic violence.
The PMTCT Program encourages HIV infected pregnant women to join Support Groups, and refers them to the MTCT-Plus Program for evaluation and treatment.
MTCT Plus cares for newly-identified HIV infected pregnant women, some Support Group members and some HIV-infected CBCHB healthcare workers.
The Infection Prevention Program assures that hospitals and clinics do not perform unsafe practices that could expose patients to HIV, and provides HIV testing and post-exposure prophylaxis to employees with occupational exposure.
The Adopt a Health Care Worker Program cares for employees who are not covered by MTCT Plus, thus helping to maintain a stable health care workforce.
Infants and children orphaned by AIDS or other causes are registered as Chosen Children and are eligible for benefits from Chosen Children Program. Caregivers of Chosen Children participate in Support Group meetings.
The PMTCT and MTCT-Plus Programs screen pregnant women for TB and refer those who are positive to the TB Control Program for treatment and follow up.
The TB Control Program screens patients for HIV and refers those who are positive to Support Groups, MTCT Plus, Adopt a Health Care Worker, or CBCHB physicians for follow up and treatment.
WINHEEDCAM and MUGFIC provide micro-enterprise loans to support group members and foster parents of orphans to enable them improve on their income level.
The Cervical Cancer Prevention Program prioritizes screening Support Group women since they are at higher risk of cervical cancer.
The Palliative Care Program accepts referrals of very ill, pain-stricken individuals from MTCT Plus, TB Control, PMTCT, and other programs.

The COPE Program trains all CBC health workers to consider all patients as “clients” who deserve respect, autonomy, and continuous improvement in quality of care.

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Conclusion

The CBCHB ACP is a comprehensive, ongoing program, and is open to all partners interested in joining us in the fight against HIV and AIDS.

acp
Family photo of AIDS Care and Prevention Program (ACP) staff after
Coordination meeting in November 2007
 
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