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MSF in Mozambique , 2010
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Despite Mozambique’s recent economic growth many people in the country remain dependent on international aid. Of the 1.6 million people living with HIV, about 430,000 are in urgent need of life-extending antiretroviral (ARV) treatment. Along with HIV, tuberculosis (TB) presents a serious public health concern, and up to 60 per cent of TB patients are also infected with HIV. For the majority of Mozambicans, access to healthcare remains very limited and the frail healthcare systemstruggles with the high number of people infected by both HIV and TB.
MSF started caring for patients with HIV in Mozambique in 2001, striving to demonstrate the feasibility of treating HIV in poorly resourced urban areas, such as Chamanculo and Mavalane in the capital Maputo, and in remote areas such as the northern provinces of Niassa and Tete. Over the past decade, MSF has established standardised procedures for HIV care and treatment, paying special attention to treating HIV and TB co-infections.
With the number of people receiving ARV treatment steadily growing, it has become harder to enrol people in treatment programmes, especially in areas where there are no hospitals close by. MSF has focused on moving HIV care and treatment from central hospitals to local health clinics. This vital step has been successfully implemented in many of MSF’s HIV programmes in Mozambique.
The comprehensive HIV/AIDS programmes offer testing, pre- and post-test counselling, treatment and prevention of opportunistic infections that can occur as a result of a compromised immune system, psychological support, paediatric diagnosis and treatment, and prevention of mother-to-child transmission. At the end of August 2010, more than 200,000 patients were receiving ARV treatment in Mozambique, some 33,000 of whom were being treated with the assistance of MSF.
Shortages: doctors and drugs
To ensure that patients get care and treatment despite the country’s shortage of healthcare workers, MSF is trying to develop programmes such as task-shifting. Task-shifting trains nurses to independently assess patients, diagnose and treat opportunistic infections, and initiate and monitor ARV treatment, thereby taking on some of the responsibilities of doctors. Where the supply of HIV and TB drugs falls short, MSF also provides a buffer supply of HIV and TB drugs to health facilities where it works.
Community ARV groups
In rural Tete province, MSF has piloted community ARV groups, which empower HIV patients to participate in the management of their disease. Consisting of about six neighbours, the group selects one person each month to visit the health centre to collect the ARV drug refills for everyone. The representative has a medical check-up while at the health centre and, upon returning, distributes the drugs to other group members, who sign in to confirm that they have received their refill. The community group system ensures that members adhere to treatment and enables group members to support each other in overcoming the stigma associated with HIV/AIDS in their communities. Treatment complications, however, are addressed during clinic visits.
This model has reduced the burden on healthcare services, since fewer patients need to queue at health centres for their medication. It has simplified how patients in remote areas obtain their ARV refills and helped those who cannot sacrifice a day at work for a trip to the clinic. The Ministry of Health has adopted the concept and community ARV groups are expected to be established nationwide.
In September 2010, MSF teams conducted an epidemiological survey in Niassa province following reports of measles cases and an epidemic in neighbouring Malawi. As a result, MSF staff worked with the Ministry of Health to conduct a measles vaccination campaign: 250,000 children were vaccinated in six districts. MSF staff helped plan the logistics of the campaign and trained ten vaccination teams from the Ministry of Health.
MSF has an emergency preparedness system in Mozambique that is ready to respond to natural catastrophes and outbreaks of disease in support of the national emergency bodies.
MSF has worked in Mozambique since 1984.