ICAP News - February 2009

Traditional Birth Attendants in Nigeria Link Pregnant Women to HIV Services
In Nigeria, two-thirds of pregnant women give birth in their homes. Instead of seeking out health care providers, most women turn to traditional birth attendants who monitor their pregnancies and assist with deliveries.

In an effort to link more pregnant women to HIV services, particularly prevention of mother-to-child transmission (PMTCT) of HIV, ICAP is working closely with high-volume traditional birth attendants in several Nigerian communities. Since the program was piloted last year in Ogoja and Kafanchan, 36 traditional birth attendants have received training in when and how to refer pregnant women for HIV counseling and testing. Other training topics focus on universal precautions for preventing HIV transmission and assisting pregnant women with the administration of antiretroviral drugs for PMTCT.

During the pilot phase of the program between August and October 2008, a total of 138 pregnant women were registered with traditional birth attendants in the Ogoja area, of whom 85 had unknown HIV status. Traditional births attendants referred and escorted 77 of these women to HIV service sites for counseling and testing. In addition, of the 53 pregnant women of known HIV status, six HIV-positive individuals were referred for care and treatment, including PMTCT.

“Traditional birth attendants can play important roles in linking pregnant women to HIV services,” said ICAP-Nigeria Country Director Bola Oyeledun, MD. “We look forward to working with many more of them to help ensure more pregnant women access counseling and testing, care and treatment, if indicated, as well as have safe deliveries.”

Photo caption: A traditional birth attendant examines a pregnant woman.

For more about ICAP Nigeria, visit here.

Rwanda Hospital: ‘A Working Model’ of Integrated HIV and Mental Health Services
HIV presents unique challenges for people with mental illness. In addition to increasing their vulnerability to HIV, mental illness can compound psychological issues associated with living with HIV.

In an effort to address this complex issue, ICAP and Rwanda’s Treatment and Research AIDS Center (TRAC-Plus), in collaboration with the Ministry of Health’s mental health program, have been working to integrate HIV services and mental services. Recently, Ndera Neuropsychiatric Hospital, Rwanda’s national psychiatric referral hospital in Kigali, became the first mental health facility in the country to provide comprehensive HIV services.

In 2007, HIV prevalence among inpatients at Ndera Hospital was estimated at 16 percent, much higher than the national adult prevalence of 3 percent. Before HIV services were initiated, most of Ndera’s patients obtained HIV care and treatment at other facilities. Provision of HIV and mental health services at the same location is expected to improve quality of care for both conditions.

ICAP and TRAC-Plus have supported an array of on-site training programs focused on integrating provider-initiated HIV counseling and testing as well as HIV care and treatment into routine mental health services. A planning workshop was also held to develop guidelines for areas of special clinical relevance for psychiatric patients with HIV. The ICAP clinical unit continues to provide mentorship and supportive supervision as the hospital scales up HIV services.

“The partnership among ICAP, TRAC-Plus, the Ministry of Health, and Ndera Hospital addresses the critical need for HIV services for mental health patients, one of our most vulnerable populations,” said ICAP-Rwanda Country Director Ruben Sahabo, MD. “We are excited that Ndera Hospital will serve as the first working model for integrated HIV/mental health services in the country.”  

Pamela Collins, MD, MPH, assistant professor of clinical epidemiology and clinical psychiatry at Columbia University’s Mailman School of Public Health, has been working closely with ICAP Rwanda to support the integration of HIV and mental health services at Ndera Hospital.

For more about ICAP Rwanda, visit here.

HIV Services Initiated at Côte d’Ivoire Prison
ICAP-supported Bouaflé Prison in central Côte d’Ivoire recently became one of the first prisons in the country to provide voluntary HIV counseling and testing as well as access to care and treatment.

Since services were initiated last year, 246 individuals have obtained HIV tests and 16 individuals have tested positive. Those who test positive are referred to ICAP-supported Bouaflé Regional Hospital for care and antiretroviral therapy, if eligible.

The prison’s sole provider, nurse Digbehi Edmond, provides both general health care and HIV services, including counseling and testing, collecting and transporting blood samples to the laboratory, and accompanying HIV-positive inmates for follow-up visits at the hospital. He is assisted by ICAP clinical advisors, who provide on-site training, clinical mentoring, and supportive supervision. In the long term, ICAP plans to equip the prison with a motorcycle to facilitate the transportation of laboratory samples.

“We believe that prisoners have a right to health care, including HIV care and treatment,” said ICAP-Côte d’Ivoire Country Director Ida Viho, MD. “In addition to Bouaflé Prison, we are supporting a range of facilities in the five regions where we work to ensure that the entire population has access to HIV services.”

Photo caption: Nurse Digbehi Edmond examines a patient in the prison's infirmary.

For more about ICAP Cote d'Ivôire, visit here.

Pharmacist’s Assistants Students Pass Training Certification Milestone
On Feb. 20, the first seven students to enroll in an ICAP-supported training program for pharmacist’s assistants in Eastern Cape, South Africa, reached the basic certification level. The training program is designed to help address the severe shortage of pharmacists, especially in rural areas, who can dispense HIV medications.

For the second year of the program, students will continue their studies at Nelson Mandela Metropolitan University and apprenticeships at ICAP-supported government hospitals under the guidance of South Africa Pharmacy Council-approved tutors. After earning post-basic level certification, they will be able to perform most of the functions of public health clinic pharmacists. ICAP hopes the graduates will remain at their training sites, many of which have a shortage of registered pharmacists.

“The students are already proving to be invaluable assets to the training sites by helping the overwhelmed pharmacists,” said ICAP-South Africa Country Director Tshi Neluheni, MD. “We look forward to their completion of the post-basic level portion of the program in 2010.”

An additional ten students were recently recruited to the pharmacist’s assistants training program.

For more about ICAP South Africa, visit here.

Photo caption: Pharmacist's assistants students revel in their graduation from the basic certification level of the training program.

March Draws Attention to HIV Services at Tanzania Clinic
Wearing bright yellow ICAP t-shirts, more than 600 health workers, people living with HIV, and ICAP staff marched through Mlandizi, Tanzania, to draw attention to the initiation of HIV services at the local health center. The facility, whose development was supported by ICAP and the U.S. Centers for Disease Control and Prevention, serves more than 70,000 residents of Kibaha District in Pwani Region.

“The march was symbolic of the commitment of the health center’s staff, ICAP and its partners to ensure that people in the community access its services,” said ICAP-Tanzania Country Director Amy Cunningham. “We will continue working closely with the center as it scales up high-quality HIV services.”

Mlandizi Health Center provides comprehensive HIV services in an integrated manner, including prevention of mother-to-child transmission of HIV, early infant diagnosis, and tuberculosis/HIV care and treatment. Among other activities, ICAP provides ongoing clinical mentorship and supportive supervision to staff at the site.

Photo caption: More than 600 people marched through Mlandizi to promote newly initiated HIV services at the local health center.

For more about ICAP Tanzania, visit here.

Laboratory Experts Review Challenges, Opportunities, and Best Practices from PEPFAR’s First Five Years
On Jan. 26-27, ICAP-Columbia University in New York hosted a meeting of the Laboratory Technical Working Group of the U.S. Centers for Disease Control and Prevention Global AIDS Program. During the meeting, representatives of 25 implementing partners of the President’s Emergency Plan for AIDS Relief (PEPFAR) reviewed laboratory-related challenges, opportunities, and best practices in supporting the objectives of first five years of PEPFAR.

Participants also considered strategies for supporting PEPFAR’s next five years, including needs for consensus on critical laboratory indicators and standardized approaches for the implementation of Quality Management Systems. They also discussed the role of laboratories in health systems strengthening.

“The meeting provided a terrific opportunity for PEPFAR partners to share experiences about strengthening the laboratory network for HIV services,” said Jessica Justman, MD, director of ICAP’s University Technical Assistance Program. “We generated many new ideas on how to move forward with laboratory support over the next five years.”

In opening remarks, Linda Fried, MD, MPH, dean of the Mailman School of Public Health, welcomed participants to the meeting.