Posted by: afedorova | 09/09/2009

Cross-Cutting Benefits, Lessons of HIV/AIDS Investments

GHC Policy Communications Coordinator Vince Blaser is traveling in Zambia and Tanzania to visit member programs and report on policy connections. This is the sixth of his reports.

ARUSHA, Tanzania – Anna Aron, 36, might not have been thinking about the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) or President Obama’s Global Health Initiative when she spent much of the money she had Tuesday to take a taxi to the maternity ward at the Oltrumet health center about a half hour outside Arusha.

But seeing the facilities in which Aron was treated while traveling to Oltrumet and other clinics in the region with staff from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), a couple observations seemed to codify:

  1. Investments in HIV/AIDS Counseling, Treatment and Care (CTC) units have prevented cases of HIV and benefitted entire health facilities; and
  2. The CTC facilities are often some of the newest and nicest at the clinics, leading me to believe that investments across other health sectors could have similar benefits for other units at the facilities.

EGPAF, with support from PEPFAR, the U.S. Centers for Disease Control (CDC) and partners such as GHC members the Abbott Fund and the University of California-San Francisco, has helped supply training, lab equipment, transportation assistance, antiretroviral drugs and other services with the aim of improving prevention of mother-to-child transmission (PMTCT) of HIV/AIDS in the region. Out of the 190 facilities in the region that provide reproductive and child health services, 143 now offer PMTCT services, said Angelina Kanya, regional team leader for EGPAF.

The benefits can be seen in stories like Aron’s. She came to Oltrumet to deliver her fourth child – the other three having been delivered elsewhere. Aron tested positive for HIV before delivering her infant, who was given antiretrovirals to prevent transmission of the virus to her newborn daughter. Aron said that she preferred the treatment she received at Oltrumet to the other facilities she had delivered her other children at – an indication that the investments made in the clinics CTC center has some benefits beyond HIV.

Now, not all the clinics I visited had sparkling CTC facilities (although the Monduli District Hospital about an hour from Arusha sure did). Dr. Isir Ismail runs the CTC center at the Ngarenaro Urban Health Centre in the heart of Arusha out of a small room, but the presence of investments in tackling the HIV/AIDS epidemic in Tanzania were also apparent at Ngarenaro. A couple who had come in for a prenatal visit agreed with staff at the facility that they should be tested for HIV. The initial results were that the woman might be positive and the man might be negative, but the availability of the Unigold tests as a third check showed both were negative – a result that would not have been delivered before these tests were available.

All of the facilities I visited said they have solid referral systems in which staff literally walks clients from one unit to the other in an attempt to make sure clients are actually going to receive the services they need. Dr. Frederick Ndosi, who heads up the CTC at Monduli and was acting head of the hospital Wednesday, said that clients would prefer all services (such as HIV/AIDS, family planning, TB, etc.) be at the same point of contact but added that would be very expensive. Dr. John Makundi, Mounduli District AIDS Control Coordinator agreed, adding that the home-based care increasingly in use in Mounduli is providing services across sectors – very important for this district as 60 percent of the population are Masai, who are frequently are on the move to different areas of the district.

A combination of increased home-based care, continued solid investments in HIV, as well as elevated assistance for units such as maternal, child and reproductive health might be the correct prescription to improving overall health outcomes in some regions. I’m now traveling to Dar es Salaam to look at tying that whole health system together, including the role of public-private partnerships.

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