Hiv Free Northwest & Southwest

 

HIV Free Southwest and Northwest Project, Activities

HIV-Free NW Project Updates: 2015 EXECUTIVE SUMMARY

Executive Summary

By Clementine MBI/ Alphonse ABANDA

>          Project year four activities started this April and seek to achieve the year four targets per objec- tives (See April Update).
>       44 personnel drawn from 17 care and treatment centres in the Northwest were trained on psycho- social support for Children Living with HIV to improve the quality of care for CLWHIV. The training took place on 20th-24th April, 2014. Statistics of a study carried out by CBCHB in the NW and SW regions in 2014 revealed that only 3.4% of HIV infected children are on Anti- retroviral therapy (ART) in the SW and 6.25% in the NW. These figures are low, compared to the percentage of adults on treatment. The training was part of activities for the Accelerated Children’s Treatment (ACT) Initiative, a new project sub component that seeks to identify, treat and keep all CLWHIV on treatment.

>         The NoA for the PEPFAR call issued in 2014 to expand and improve PMTCT services in the Littoral and Centre regions were released. The CBCHB proposals in both regions were success- ful. In the Littoral, CBCHB will provide services to about 85% of the population together with her consortium members, EGPAF and CHP while in the Centre region, CBCHB will work with CHAI to provide services to about 75% of the population. It is worth noting that CBCHB shares both regions with ICAP and partners.
>          Coordination teams continued to provide facilitative and supportive supervision and noted im- provements in Services Quality Assurance and Data Quality Assurance at most of the sites. Dif- ficulties continue to persists at sites where trained staff are transferred. Staff  of the coordination units continued to attend district level meetings and trainings to share information and improve performance.
>        The project implemented an innovative approach that consisted in meeting men in their social groups commonly called “Njangi” houses in a bit to improve male participation at ANC. This approach seems to be paying off as the number of men who accompanied their pregnant partners to ANC in Ashong increased. Similar improvements in this indicator have been recorded in Nwa health district due to increased sensitization.
>         The project continued to increase access to HIV testing for people in remote settings through outreach VCT campaigns. Mass VCT campaigns were carried out in Mbengwi, Ndu and in LAP community. In total, 699 persons were tested for HIV. All 5 pregnant women who turned out for screening for their first time had negative results. 2 breastfeeding mothers tested positive. The DBS of the children were collected for PCR testing and results came back negative. Six persons tested HIV positive and were all linked to care and treatment while those who tested HIV nega- tive were counseled on healthy living habits.

>         According to reports from the PMTCT coordinator in Nkambe ANC uptake has increased in the Nkambe coordination area. The increase has been attributed to outreach ANC services carried out in previous months. There has also been marked improvement in documentation across the coordination area.

The work of the PMTCT staff in Nkambe  particularly in the area of supervision was applauded in
April by a Performance Based Financing team from Yaounde.

>         The project continued to improve follow-up, support and initiation of HIV positive children into treat- ment.  The coordination team in Wum identified two HIV positive children and returned them to care. The support was extended to the breastfeeding mothers whose ARVs were collected and sent to them to ensure they stay on treatment despite their complaint of lack of transportation.

>        Still in Wum, two HIV positive breasts feeding mothers at Weh and PHC have deliberately refused to do PCR for their children and CD4 count for themselves. If nothing is done, they both risk transmitting the virus to their babies. The project team in Wum is however working hard to avoid this from happening. Counseling for the recalcitrant mothers has intensified!

>        PMTCT staff in Mbingo visited CEMADIT, a newly approved PMTCT site under the Mbingo coordina- tion area and conducted site assessment and an on-the-site training to ensure quality PMTCT services delivery.

>         Through continuous supervisory visits, the PMTCT team in Bafut found out that the cost of registration for Ante-Natal care (ANC) services maybe a major obstacle for ANC uptake in Bafut health district. According to the coordinator, some pregnant women have been unable to pay the ANC booking fee of
19,000 francs CFA and they go back home without being tested for HIV. This went on unnoticed by the
authorities since the amount was not paid as lump sum but was done at different points of the process. The PMTCT Supervisor and coordinator  had a meeting with the Chief medical Officer of the Bafut Dis- trict hospital to ensure the cost burden of ANC booking is reduced.

>       The M&E team visited nine health districts and facilities in the NWR to give PMTCT M&E feedback and to lay down the recommendations made by CDC Atlanta to the Chiefs of Centres and facility staff
for implementation. Following the quarter one of 2015 quantitative report, some 12,551 pregnant women
attended antenatal clinic in the North West with 9.2% of their partners tested for HIV. 93.4% of the HIV positive pregnant women received the recommended treatment to reduce mother to child HIV transmis- sion while 92.2% of the HIV exposed infants were treated. The team is planning to intensify DQA activi- ties beginning with high volume ANC sites in the different coordination areas.

>        FHI360 based in USA organized a four day workshop from the 13-16 April, 2015 at the Health Services Complex, Mutengene to empower 12 CBCHB staff on advocacy and policy related issues. Main facilita- tors at the workshop were Amita and Tracy both of FHI360 and  Dr. Ndonko Flavien, FHI360 consultant in Cameroon and Mr. Foyeth Eugene, the CBCHB Policy and Advocacy Advisor. A major resolution
after the training was the need to create an Advocacy Task Force to lead all policy advocacy issues relat-
ed to the LCI.

>       The training of CBCHB staff on Policy Advocacy strategies was immediately followed by a similar training for two stakeholders drawn from each of the ten LCI districts in the NW/SW Regions. They gained basic knowledge and skills on policy advocacy to enable them address policy advocacy issues in their various communities.

>      A Peer Educators’ meeting held on April 28, 2015 during which Peer Educators working at Option B+
sites in the Northwest shared success stories and field experiences as part of peer learning.

HIV-Free NW Project Updates: March 2015 EXECUTIVE SUMMARY

HIV Free NW Project Updates: March 2015 Executive Summary.

By Mbi Clementine/Abanda Alphonse.

  • First rains began in the NWR this March but did not however disturb implementation.
  •  There was the regular supportive and facilitative supervision of PMTCT sites in all coordination areas. Many sites were visited and Data Quality Assurance (DQA) as well as Service Quality Assurance (SQA) was conducted. Loopholes identified in PMTCT service delivery were handled. This exercise revealed that documentation remains a serious problem in most facilities. Also, coordinators and supervisors noted that PMTCT services were badly affected as a result of the transfer of staff at some sites. This is the case with Benakuma health district where nine PMTCT staff were transferred since the beginning of 2015 and some facilities within Bamenda  health district.
  •   As usual, the International Women’s day was commemorated in pomp and pageantry across the region. Various coordination areas involved pregnant women in the sensitization for ANC up-take during Women’s Day. In Wum Health District, a VCT for HIV campaign was organized during which 60 people were screened, with two women within child bearing ages testing HIV  positive for the first time since the project began conducting VCT. They were counselled on nu trition, secondary prevention, drug adherence and referred for CD4 at Wum district hospital. A similar exercise took place in Bamenda where 42 persons were screened for HIV: 36 women and 6 men. A woman between 20 & 24 years who tested HIV positive was linked to Care and treatment. The screening in Bamenda was done in collaboration with the Regional Delegation of Women’s Empowerment and the family; with other screenings like cervical cancer/breast screening inclusive. Ten of the 149 women who turned out for cervical cancer screening already knew their HIV positive cases and are taking treatment.
  •  The project journalist carried an unannounced visit to an ANC facility to produce a special radio program on male partner involvement at ANC. During this visit it was observed that unlike what obtained at previous visits, more and more men are accompanying their partners for Ante Natal Care services, though in a slow manner. Commenting on this, the M&E Supervisor Mr Keng Vitalis, asserts that we may expect to witness better trends in Male Partner involvement in the new project year. In 2013, 8.1% of the men were seen at ANC against10.7% in 2014 putting the growth rate in male participation at2%.
  •  The project began the installation of hematology and Biochemistry counters in Ndop District Hospital, Banso Baptist Hospital, and Mbingo Baptist Hospital. The staff of the C&T centers  concerned were trained to operate the machines appropriately during the installation.

HIV FREE NW PROJECT HIGHLIGHTS

  •  A meeting for Bikers in the NWR held in Bamenda on March 27, 2015 during which they signed their new contracts. According to the new contract, Bikers are to use their personal bikes to carry out their duties. This means that the project will no longer purchase bikes as was the  case before. This decision was arrived at by Management as a way of ensuring the sustainability  of this approach.
  •  The project has continued to collaborate with district and facility teams to improve Pediatric C&T across the region. Besides scaling up the innovative Child Play Centre approach across the region, the project also held a meeting with Care and Treatment staff at the Mbengwi District Hospital on March 26, to brief them on issues around paediatric HIV C&T with the aim to improve the delivery of such services in the facility.
  •  Four new TBAs who were identified in the Ashong coordination area were trained on PMTCT and strategies of referral and encouraged to avoid conducting home deliveries. They are expected to start reporting to the district by the end of April, 2015.
  •  The Health Fairs organized in LCI districts wrapped up in March with Benakuma, Mbengwi and Ako health districts. Like in the previous ones, during these first ever health fairs the population had access to free eye screening, diabetic screening, stool analysis, VCT for HIV and AIDS and screening for high blood pressure and weight. Cumulatively, close to 2000 people turned out for the health fairs with 850 accessing free VCT for HIV. Of the number screened for  HIV, 18 tested positive. In total, 163 pregnant women showed up for their first ANC during the fairs with four testing HIV positive and were all linked to PMTCT services. All other community members who tested positive were referred to C&T.
  •   The Advocacy and Policy Advisor, Mr. Foyeth Eugene continued his visit of the five health districts that are implementing the LCI Project. In the North West, he visited Mbengwi, Bafut, Tubah, Benakuma and Ako Health Districts and met with Government Officials, Hospital Administrators, local authorities and leaders of civil society organizations in those districts to initiate contacts with them and create a platform for brainstorming on challenges identified. Also, together with these stakeholders he began elaborating Advocacy and Policy Plan of action for each LCI district.  
  •   An Option B+ supervisors’ meeting was held in Bamenda on March 18th to assess the on going implementation process in all facilities and device strategies that will effect quality services in all domains. This critical meeting was chaired by the Principal Investigator, Professor Tih.
  •  Also, following the challenges faced in tracing HIV+ women at the non B+ sites, some coordinators in their monthly supervision reports have recommended the need to speed up the scale up of Option B+ to all sites.

HIV-Free NW Project Updates: FEBRUARY 2015 EXECUTIVE SUMMARY

Key activities that marked this month included mass VCT campaigns, meetings, trainings and the start
of LCI Health Fairs in some Health Districts.
By increasing VCT campaigns for HIV, the HivF project was able to further take testing services closer to the people especially those in remote community settings. To quote the Supervisor of Laboratory
Services for the CBCHB-Mr.Tancho Samuel, “VCT has greatly improved on the AIDS Care and Prevention Program (ACP)”.
In February, the project conducted mass VCT campaigns in the Bamenda, Mbengwi, Banso and Wum
coordination areas. A total of 1,394 persons were tested with 15 HIV positive. Of the 31 pregnant
women tested, 01 was HIV positive. All positive cases were linked to Care and treatment. The VCT
campaign in Banso revealed that home deliveries are still very rampant in the area. Of the 12 pregnant
women seen in Banso during the VCT, 8 had not started ANC. They were immediately enrolled into
ANC and educated on the dangers of delivering at home.The PMTCT Regional Coordination meeting that held in February brought together all PMTCT staff to take stock of activities undertaken during the last quarter and plan future areas of focus. This aimed at improving results. The project manager Ms Kuni Esther used the opportunity to appreciate the field staff  for  their  hard  work  before  encouraging  them  to  work  harder  so  that  the  project  may  reach  its 96,000 target.The M&E team presented the overall impact of the 2014 mass VCT campaigns on testing uptake. During the 2014 mass VCT campaigns 330 pregnant women, of whom 275 who had never attended ANC before were tested. Some  10  Peer  Educators  drawn  from  selected  10  Care  and  Treatment  centers  in  the  Northwest  received training in February to improve quality of linkages and client follow ups for C&T services. Addressing the trainees, the PI-  Prof. Tih cautioned them to embrace their job and relent at nothing to make their impact felt in the domain of C&T of PLWHIV. For two days, the PEs received knowledge that will enable them serve adult and pediatric HIV clients with care and love. Also, Children support group activities began at some of the pediatric clinics. In Ndop, Shisong, BBH and Nkambe district hospitals, where children support group activities commenced, the people have highly appreciated it as it leads to holistic care offered to children in those communities. These children were  grouped into  3 different age brackets; 0-10yrs, 11-13yrs and  14-19years so that they  can learn appropriately in their suitable context. At these centers, children are assessed and monitored on side effects of drugs. The centers have been equipped with toys so as to make them a real paly center that attracts the children. Efforts to improve other pediatric clinics in other C&T centers are ongoing.In February, the Local Capacity Initiative (LCI) worked with the District Health Management Teams and Councils of Bafut and Tubah to organize the first editions of the Annual Health Fairs in the two districts which held on the 17th and 25th respectively. The Health Fairs aimed at increasing community awareness on health services available within the respective communities and to increase HIV testing services through free voluntary screening. Other health care services that were offered during the health fairs include eye care, general screenings, consultations and vital signs monitoring, ANC services and distribution of mosquito bed nets. The events were also characterized by health talks on HIV and AIDS with focus on PMTCT. In Tubah and Bafut, the fair brought together about 1,000 persons, of whom 92 had access to eye screening (in Tubah), 40 women accessed ANC (in Tubah), 251
Fasting Blood Sugar (FBS), Blood Pressure and weight, 339 turned up for HIV screening, out of
whom 10 tested positive and were referred to the treatment centers. The health fairs in Benakuma,
Mbengwi and Ako Health districts were planned for March. Other LCI activities include documenting
information on available and functional health services, committees and CBOs within each of the target districts.
Facilitative  and  Supportive  supervision  went  on  smoothly  in  all  coordination  areas.  A  large  team
made up of CBCHB and Wum District staff conducted an intensive supervisory exercise in Furu-Awa
health area. In total, there was a team of 30 persons amongst whom were nurses, physicians and M&E
officers. Besides providing routine site supervision, the team also carried out a mass VCT campaign
for HIV and took part at a trans-border meeting chaired by the NW Governor Adolph Lele L’Afrique
Deben  Tchoffo  and  the  NW  Regional  Delegate  for  public  Health.  Present  was  a  health  delegation
from Nigeria. Among the topics discussed during the trans-border meeting were how to capture statistics for vaccination, PMTCT and other health activities in the boarder villages. This shows the effectiveness of the project’s advocacy and partnership building efforts. In partnership with the US Peace Corps in Cameroon, CBCHB conducted training workshops for Peer Educators, counselors and People Living with HIV (PLWHIV) in Fonfuka, Buabua and Konene.
In February, the CBCHB received another award from the renowned Anglophone daily; Cameroon
based newspaper, the Guardian Post. CBCHB emerged victorious after anonymous votes for the category “Services to Humanity” for outstanding work in HIV and AIDS, specifically PMTCT in Cameroon”. While receiving the Award on behalf of CBCHB, the Documentation Supervisor of the HivF
project Mr. Abanda Alphonse said “The work of the CBCHB will not be complete as long as there are
still people in need of quality health care in Cameroon!”
The B+ team intensified supervision to ensure effective implementation at the 46 new sites now offering the B+ regimen. New sites supervised were in Ako, Nkambe, Nwa, Kumbo East, Kumbo West,
Oku and Ndop Health Districts. Reports indicate that the level of implementation at these new sites is
very satisfactory.
The documentation supervisor and the CRTV team visited the health districts of Wabane, Mamfe,
Eyumojock and Nguti in the Southwest region. The TV documentary to be released from this trip will
bring to light the ordeal the people go through in their frantic search for quality health care as a
whole, and PMTCT in particular. Their findings revealed challenges in poor road network that leads
to difficulty in accessing health care services, lack of radio/TV signals, low staff strength, distant location of health facilities which leave the inhabitants at the mercy of TBAs. There are plans to carry
out a similar documentation exercise with same focus in some health districts of the NWR.

HIV-Free NW Project Updates: JANUARY 2015 EXECUTIVE SUMMARY

Several activities marked kept the entire project staff at all levels very busy throughout the month of
January.
All the 19 health districts of the Northwest region received training on the use of the PMTCT/MNCH
tools. Organized by ICAP, the two-phase training was realized thanks to the collaboration of the
CBCHB Monitoring and Evaluation (M&E) Office, the Regional Delegation of Public Health and district health services. This shows how CBCHB works collaboratively with other actors to ensure quality
health care delivery.
A supervisor’s meeting held on January 21, 2015 to ensure a smooth progress in the on-going activities of the project activities and to plan for better results in year, 2015. During this meeting PMTCT
supervisors confirmed that ICAP registers were now available at all sites, that the QI knowledge
gained by service providers was now being widely applied. Also, it was reported that the 2015 work
plan developed by CDC, NACC and CBCHS were being followed. Supervisors also brainstormed on
possible opportunities to improve services and proposed new approaches to improve on ANC uptake
which is still below target despite the hard work on the field.
Management met to streamline/prioritize activities and budget for the last quarter of FY3- given that
FY3 was longer as a result of CDC Atlanta’s no-cost extension of the execution period from 12 to 18
months, in order to align actions to the new US PEPFAR budget period. Activities for the remaining
three months of FY3 were adopted. The PI, Prof. Tih indicated that the stagnating ANC1 uptake remains a major concern and more resources needed to be directed towards activities that will help improve this particular indicator by the end of the project year. In planning activities for these three remaining months of FY3, management ensured that all the activities were linked to the project objectives and key project indicators as required by CDCSite assessment visits were conducted in all coordination areas. These included Quality Improvement, facilitative and supervisory visits, onsite trainings and mentoring. PMTCT staff were engaged not only in routine activities but also in the assessment of quality services following previous recommendations at all levels.
Outreach VCT in Banso and Bamenda registered 4 HIV positive pregnant women who were all linked
to care and treatment, ie 3 in Bambenda and one in Kuvlu Banso. The PMTCT team in Wum conducted mass VCT in Bafmeng, Befang, Weh, Kumfutu, Bu, Modelle, Baworo which are all hard-to-reach
areas. During these visits, Peer Educators and Bikers for Health whose activities are very valuable to
the project in these localities were given more directives on their daily activities. A 10 year old boy
whose mother recently died of HIV in Wum was tested HIV positive and initiated to treatment.
The PMTCT supervisor, Mr Nkuoh Godlove carried out intensive supervisions in Mbingo, Batibo,
Mbengwi, Bamenda and Wum coordination areas during which he saw the need for Ndop health district which is administered as part of Mbingo coordination area to be carved out and added to Banso
coordination area to ease and improve supervision.
The project hired a Policy and Advocacy Advisor, Mr. Kamdem Foyeth Eugene to work closely with
local councils and communities under the Local Capacity Initiative (LCI). His advocacy work will
help to strengthen objective 7 of the project.
A management meeting held with the Policy and Advocacy Advisor to have an overview of how policy and advocacy issues will be handled.
Other LCI activities this month included capacity building. A workshop was held in Ako, organized
and facilitated by community stakeholders who were earlier trained as trainers. The training in Ako
aimed at strengthening the leadership and supervisory capacities of community stakeholders for sustainable HIV and AIDS activities within their districts.
In their report, the M&E team indicated that in 2014, some 4,070 (99.6%) PMTCT data were received
from the 344 PMCT facilities. Services were offered to 48, 224 pregnant women at first antenatal
clinic, with 99.9% HIV testing acceptance rate. Of the pregnant women tested HIV positive, 2,633
(90.7%) received recommended treatment to prevent mother to child HIV transmission. 2,388
(103.3%) of the HIV exposed infants received prophylaxis at birth leading to 129 (6.3%) PCR positivity rate. 5,172 (10.8%) of partners of pregnant women who accompanied their spouses to antenatal
clinic were counselled and tested for HIV.