In November 2012, Ark marked the formal handover of our HIV care and treatment programme to the Mozambican government. Our four-year programme has improved the lives of more than 36,000 children and the Ministry of Health is in the process of scaling up many of the innovations nationally.
Mozambique has the second highest rate of new adult HIV infections in the world. More than 1.4 million people live with the virus and an estimated 670,000 children have lost one or both of their parents to the disease.
When we started working in Mozambique in 2008, doctors and medical technicians were the only clinicians allowed to treat HIV-positive patients. With only four doctors for every 100,000 people, too few trained staff meant that few patients - especially in rural areas -could be enrolled on life-saving Anti-Retroviral Therapy (ART).
It was also hard to identify those patients who should be starting treatment: only a handful of central hospitals had the equipment to monitor whether patients were ready to begin ART. Thousands of patients were being lost, either due to advanced illness or because protracted waiting times meant they never returned for their results.
In partnership with the Ministry of Health, we launched our four-year programme in five public health facilities in Maputo Province. Our aim was to create a sustainable model of care to keep HIV-positive parents, carers and children alive.
We chose Maputo Province because of the high prevalence of HIV, where nearly 20% of adults are infected. We:
- Trained health workers in HIV care and treatment.
- Introduced point-of-care treatment to enrol patients in ART faster.
- Piloted SMS messaging to keep patients on treatment.
Through mentoring and on-the-job training, we made sure that more health agents were able to take care of HIV-positive patients. Training 132 nurses and health workers helped us to enrol 17,764 new patients on ART.
Together with the Clinton Health Access Initiative, we introduced CD4 machines in the health facilities we supported. The machine uses small blood samples to measure the strength of the immune system, to determine if patients can start ART. Prioritising HIV-positive pregnant women, mothers and children, we shortened diagnosis waiting times from the national average of three months to just 20 minutes.
We piloted SMS messaging to encourage patients to return to the health facility for treatment. We sent texts about appointment dates and reminders to take medication regularly. The percentage of patients who remained on treatment after 6 months of being enrolled was 96%, and 85% after 12 months, compared to the national average retention of 72%.
Our impact: Influencing policy, changing standards
Our programme helped to show that nurses and midwives were capable of both prescribing ART and monitoring patients on treatment. It contributed to shifting national policy to allow nurses, as well as doctors, to prescribe ART and look after HIV-positive patients - a first in Mozambique.
The results of point of care testing were featured in the Lancet and encouraged the Ministry of Health to introduce the technology in key health centres throughout Mozambique in 2012. The national ART scale up plan includes the introduction of point of care CD4 testing in over 200 health facilities by 2015.
We secured an agreement with the Elizabeth Glaser Paediatric AIDS Foundation's local affiliate, Ariel Foundation, to continue to fund and manage community counselling to encourage HIV-positive patients to stay on treatment.