Wednesday, 30 December 2020 19:54

Spoke Strategy Saves The Day For HIV Case-Finding In Enugu State: The Story Of Mother Of Christ Specialist Hospital, Enugu Featured

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The prevalence of HIV/AIDS in Enugu State, where Caritas Nigeria manages thirty-two treatment facilities as the lead implementing partner, presented as a masked springboard for Caritas Nigeria’s presence in the state. The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) not only estimated a 2.1% HIV prevalence rate in Enugu state but also revealed that out of 66,0000 persons living with HIV in the state, only about 25,000 persons were receiving Antiretroviral therapy (ART) as of March 2019. Thus, a treatment gap in 40,000 clients in the state became a cloud hanging over Caritas Nigeria’s 4GATES (Global Action Towards Epidemic control in Sub-national units in Nigeria) program supported by the United States government.

The ART Surge activity, which commenced in Enugu state in April 2019, was a response mechanism to the donor’s mandate implementing partners to identify and place on treatment, all unknown HIV cases in the state within eighteen months. With the ART Surge response fully operational in Caritas Nigeria-supported treatment facilities, identification of HIV positives, linkage to treatment, retention to care, and successful viral suppression after six months of treatment thus became the bull’s eye. Accordingly, the program team in the state set out to identify effective and sustainable strategies to unlock HIV case-finding potential, by working with measurable targets categorized in tiers based on service delivery facilities’ capacities.

By observation, it was discovered that most of the clients perceived to be living with HIV were in the communities. Consequently, the exigent need to ascertain if some sick people, HIV positives inclusive, sought treatment from any points outside a conventional hospital, led to investigations and the subsequent discovery that most patients, who visit hospitals for medical attention, actually got referred by health care centres such as medical diagnostic laboratories, patent medicine chemists, pharmacies, Christian healing centres and traditional healing homes (popularly known as ‘Ejete Eze Mmuo’ – loosely translated as ‘King of the Spirits’). In a bid to successfully place such clients on HIV care and treatment, it became expedient to partner with owners of the facilities where people accessed care, otherwise known as “Spoke” facilities, by provide support and incentives, in addition to building their capacities in conducting HIV testing services, with a view to referring identified positive clients to Caritas Nigeria-supported conventional treatment sites contextually referred to as “Hub” sites.

Mother of Christ Specialist Hospital, (MOCSH) Enugu, a faith-based secondary health institution and one of Caritas Nigeria-supported treatment facilities implementing the Surge strategy, is a top priority treatment Hub site. To achieve the goal of Spoke-Hub strategy, MOCSH reputed for active case-finding, partnered with a few facilities, which were sensitized and trained on HIV management and care leading to an intensified growth in numbers of case-finding. The favourable outcome motivated Caritas Nigeria program team in Enugu to extend the search for more Spoke sites through MOCSH staff, who in turn, were motivated with incentives. Worth mentioning is the fact that the intended Spoke sites – traditional/native herbal homes, mission/healing houses, private clinics and medical labs to mention a few – have seen significant sensitizations on the importance of ‘test-and-treat’, as well as capacity building, follow up visits in their localities by the program team. It is interesting to note that over two hundred Spoke sites have been activated in the state, placing Caritas Nigeria as one of best-implementing partners in case-finding with weekly double-digit producing facilities in Enugu state.
 
Ongoing Sensitization
In addition, all HIV positive pregnant women from Spoke sites are followed up with emphasis on prompt identification of the level of risk exposed infants have, with the ultimate goal of ensuring that appropriate interventions are in place; a groundbreaking success remains the negative status of high risk exposed infants. In addition, the Spoke strategy in MOCSH has been of immense benefit to HIV positive adolescents and malnourished patients, whose treatment is complemented with nutritional supplements. Also, index testing has been effective with the extension of testing to spouses and children of positive patients.

Expectedly, the road to the recorded success was quite stormy initially owing to some challenges such as identification of clients on the one hand, and defiance of Spoke facility owners on the other. However, with top-notch determination and zest, the program team jointly committed to targeted testing and prompt monitoring of results; accurate patient enrollment and retention; expedited linkage to care; the reduced rate of missed appointments; and timely refill of Spoke patient medication. True to the saying, “every cloud has a silver lining”, Caritas Nigeria cut the mustard!
 
Article By Dr. Charles Okolie and Eveln Beyan Paul
Edited by Doris Mbaezue
Read 1295 times Last modified on Tuesday, 22 June 2021 16:51

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