SEPTEMBER 2010

ICAP to Begin Work in Central Asia

ICAP has recently been awarded funding to begin programs in central Asian republics. Activities will be initiated in Kazakhstan, Kyrgyz Republic, and Tajikistan, with possible expansion to Turkmenistan and Uzbekistan. ICAP will work with the Central Asia office of the U.S. CDC to support HIV care and treatment programming, as well as to enhance monitoring and evaluation of these programs, and support systems for disease surveillance.

Wafaa El-Sadr Featured in Science, Essence, and New York Times

To commemorate its 40th anniversary, ESSENCE featured forty of today’s most prominent Black women in its September 2010 issue. Among the women singled out for their achievements was ICAP director Wafaa El-Sadr. Some of the other women featured included Maya Angelou, Oprah Winfrey, and U.S. First Lady Michelle Obama. For the full feature, click HERE.

Jessica Justman and Wafaa El-Sadr co-wrote an editorial featured in the July 9 issue of Science, on the need to re-engage in the fight against AIDS. For the editorial, click HERE.

Wafaa El-Sadr was also quoted in the New York Times article on the intersection of HIV and TB care. For the full article, click HERE.

About ICAP

ICAP was founded in 2004 at Columbia University’s Mailman School of Public Health. Now a global leader in HIV/AIDS services, ICAP supports work at more than 1,200 sites across 15 countries in Africa. More than one million people have received HIV services through ICAP.

For more information about ICAP, visit here.
For more information about ICAP leadership, visit here.

Sponsored by Doris Duke Charitable Foundation, Bill and Melinda Gates Foundation, William and Flora Hewlett Foundation, Robert Wood Johnson Foundation, Henry J. Kaiser Family Foundation, Stephen Lewis Foundation, John D. and Catherine T. MacArthur Foundation, National Institutes of Health, David and Lucille Packard Foundation, Rockefeller Foundation, and Starr Foundation.


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FOR REMOTE AREAS IN SWAZILAND, HIV CARE MOVES CLOSER

 

“ARVs are for life, it’s a commitment, like you have married them,” says Futhi Dlamini, an outreach coordinator with ICAP Swaziland’s Community Linkages Program. Futhi, age 35, is determined to remind patients of that commitment. When they default on their HIV treatment, she will sometimes walk two hours to a remote homestead to deliver her message with hope, encouragement, and practical advice on how to manage the drugs’ side effects, or how to afford transportation and clinic fees. Her patients are often her neighbors, “I know everyone, know their character and their behaviors. They trust me,” says Futhi, who has helped more than 25 patients return to a treatment regimen since she began her work in March 2010.

Futhi was eager to apply for one of the newly established Community Linkage Program positions initiated in early 2010 as a partnership between ICAP, the Ministry of Health, and the Nazarane Compassionate Ministries International (NCMI). The start-up of this program is funded by USAID and will be continued under a five-year grant from the Centers for Disease Control and Prevention (CDC). During her job interview, she spoke about her training in home-based health care and expressed her belief that people must first have hope and faith that they will get well before they can truly get well. Since she began working with them, her assigned HIV patients have come to believe in themselves largely because Futhi stands by them. When they miss their appointments, she shows up at their homes to find out why they’ve fallen through the cracks. If they can’t afford travel and clinic fees, she may ask the clinic to treat them on credit, or even give patients her own money. “Someone cares about them, they are not lost and it helps them feel like they can go on with life,” says Futhi.

Swaziland has the highest HIV seroprevalence rate in the world—more than a quarter of its adult 1.17 million population are HIV positive. Yet, the ratio of 122 nurses and doctors per 100,000 people living in Swaziland is well below the World Health Organization’s recommended 250. With nearly 70 percent of the population living below the poverty line, and 76 percent living in rural areas, the cost of travel to one of Swaziland’s six national hospitals is often prohibitive.

Since 2009, ICAP has been working with Swaziland’s Ministry of Health to decentralize HIV care and treatment, now available in 43 ICAP-supported clinics throughout the country. “This has had an incredible impact on adherence as patients now do not have to travel as far or pay large transport fees to reach main facilities,” says Karen Abbs, ICAP Swaziland’s Community Linkages Adherence and Psychosocial Advisor.

Based at Bhekinkosi Clinic, located in the central Manzini region of Swaziland, Futhi works closely with Expert Client (EC) caregivers. ECs, who themselves are HIV positive, are trained to advise patients about treatment adherence, and to counsel them about the psychological challenges of living with HIV. “ECs already carry a heavy burden in the clinic, and because of their high patient loads they’re not able to go out into the community to look for people who have stopped keeping appointments,” says Abbs. That’s where Futhi steps in.

Sdumo Ndzinisa, age 49, received a visit from Futhi after he stopped his treatment. Diagnosed with HIV in 2008, Sdumo began treatment at Raleigh Fitkin Memorial (RFM) Hospital in the city of Manzini, Swaziland. But soon, he could no longer afford monthly visits to RFM to refill his ARV prescription. When his case was transferred to Bhekinkosi clinic, nurses and ECs could not reach him by phone. So, Futhi hopped on a bus, then walked down a long dirt road until she arrived at Sdumo’s remote homestead. Sdumo was surprised and pleased to see her, “I felt so happy that the nurses are really looking after me.” Futhi explained that Sdumo could now receive treatment at Bhekhinkosi Clinic, less than half the distance from his home and nearly half the cost of travel to RFM. For Sdumo, a subsistence farmer, the cost now amounts to one day’s worth of food instead of two. Since meeting Futhi, Sdumo is once again taking his ARVs and checking in regularly at Bhekinkosi clinic. With Futhi’s encouragement, Sdumo has also shared his HIV status with some of his family who are very supportive.

Phindile Nhlabatsi had been struggling with side effects of ARVs since she began treatment in 2004. When she stopped coming to the clinic or taking her medicine, Futhi came to the rescue. She visited Phindile at her modest one-room house, a 30-minute walk from the nearest village, where she crafts pillows to support herself. Futhi encouraged Phindile to speak with her doctor about an alternative ARV regimen that might reduce her side effects, and explored ways to better manage and accept them. “Because Futhi was able to come and keep visiting me at home and telling me how to deal with side effects, I was able to continue, so today I am adhering,” Phindile said.

In the short time she has worked with NCMI supported by ICAP, Futhi has helped many HIV patients feel less physically and emotionally isolated and better able to care for themselves. She is also better able to care for her own family and provide an income separate from her husband. “I am independent, able to buy things for the house, able to buy things for the children. I am empowered by the work,” she says.

As more patients seek HIV care from local clinics, hospitals like RFM are increasingly able to focus on other critical HIV services including ART initiation, family planning, and preventing mother-to-child transmission of HIV. Outreach coordinators like Futhi are currently working with seven clinics throughout Swaziland. By October 2010, the Community Linkages Program under NCMI will expand to an additional two clinics. This will bring the total number of Community Linkages sites working with all ICAP partners (NCMI, World Vision, and Cabrini) to 24. Following in Futhi’s footsteps, they will help patients find their way back to treatment, and encourage their families, neighbors, and friends to get tested.

FROM THE FIELD

ICAP Reaches Million Milestone — Twice

As of September 2010, one million people living with HIV have gained access to critical services through ICAP’s work in Africa. In the same month, ICAP has passed another million mark, having screened another one million women through its PMTCT work. “These are major milestones for ICAP and key contributions in the global effort to reach the many millions more who need access to HIV services,” said ICAP director Wafaa El-Sadr. “Most importantly, it is a tribute to the partnerships established with ministries of health and other in-country organizations, the in-country leadership and to the hard working staff at the sites that ICAP supports.”

More than 15,000 Orphans Receive Nutrition Supplements

In Nigeria’s Cross River and Kaduna States, ICAP has enabled more than 15,500 orphans and vulnerable children to receive vital nutrition though supplements of Grand Vita. The food supplement is rich in protein and minerals, and made for children under 10. So far, ICAP has supported the distribution of almost 14,000 bags of Grand Vita.

The supplement can be mixed into a variety of local dishes, making the dish more palatable for children. Charity Micah from Kaduna State, father of seven year-old David, attested, “This is the 17th week since my son started using the food supplement Grand Vita. David always asks for his ‘Kunu’ [a local drink]—as he calls it. He eats more now and always wants more than I give him. Physically, he has added weight.”

Local food vendors and community leaders have also reported that with the popularity of the supplement, prices of other cereals in the open market such as rice and cassava have come down.

Nurses from Ministry of Defense Receive Training

ICAP-Mozambique recently began supporting two pre-service training courses for mid-level nurses at Maputo and Nampula Health Science Institutes. A total of 70 student nurses from the Ministry of Defense received the training. The inauguration ceremony for the courses was led by Mozambique Minister of Defense Filipe Nhussi.

Since October 2008, ICAP has collaborated with the Ministry of Health at Nampula Health Sciences Institute to support pre-service training courses for 90 new mid-level nurses. These students are expected to graduate by July 2010. In addition, ICAP recently initiated support to the Provincial Health Directorate in Inhambane Province to train 90 students in mid-level nursing, basic level maternal child health nursing, and as basic level pharmacy technicians.