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MSF in Mozambique, 2011
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In Mavalane, the biggest and most populated district of Mozambique’s capital Maputo, more than 80 percent of HIV-positive people now have access to the antiretroviral (ARV) treatment they need. Doctors Without Borders/Médecins Sans Frontières (MSF) has been continuously pushing the HIV treatment agenda in Mozambique for the past 10 years, supporting the Ministry of Health in scaling up ARV treatment across the national health system.
MSF supports five of the 11 health facilities that provide HIV care in Mavalane, as well as five of the seven health centers in a second district, Chamanculo. In November, the team completed the handover of the HIV programs in Angonia, in Tete province, and in Lichinga, Niassa province, to the Ministry of Health.
By exploring innovative methods of HIV care, MSF has demonstrated that providing and scaling up ARV treatment in low-resource settings is feasible. Staff training, task-shifting (where nurses are able to provide treatment that was once the sole responsibility of doctors, and non-medical staff are trained to do jobs once carried out exclusively by nurses), and the decentralization of services from large hospitals to local clinics have been key to bringing HIV and tuberculosis (TB) care to more people in Maputo, Angonia and Lichinga. The integration of HIV and TB care also means that patients with both diseases have access to all the treatment they need in one place.
Overall, in 2011, MSF teams provided treatment and care to 28,320 HIV patients, of whom more than 1,600 were children. They also supported a referral center for patients who need special attention. Staff assist in caring for patients with complicated conditions, such as HIV patients who are on second-line treatment, who have the cancer Kaposi’s sarcoma, who are co-infected with TB, or who are suffering severe side effects of medication, and people with other chronic diseases.
Community ARV groups
Piloted by MSF in 2008, community ARV groups are made up of about six HIV patients who come together to support each other in taking treatment, and who take turns to visit the health center. Each month, one member goes to the health center to get a check-up and pick up drugs for the whole group. The system is a practical solution to the difficulties of getting to the clinic – such as transport costs and the time the visit takes – while it also reduces the pressures on medical staff and the number of patients having to line up for treatment. Moreover, the mutual support provided by group members helps them to adhere to treatment and overcome the stigma associated with HIV.
This approach has been so successful that the national authorities have adopted the concept and, with the support of MSF, will work on rolling it out across the country in 2012. Besides assisting this national roll-out, MSF will also focus on developing a strategy for building up community ARV groups in seven districts of Tete province and on adapting the model for Maputo, to make it suitable for urban slums where HIV prevalence is high. The teams will pilot specific community groups for patients co-infected with HIV and TB, patients not yet on ARV treatment, children, adolescents and sex workers, with the goal of actively involving patients in managing their own treatment.
Staff will also start developing community-based counseling and testing services. A mobile team will travel to clinics with a CD4 machine, so that patients’ CD4 counts can be measured closer to their homes. By monitoring a patient’s CD4 count, medical staff can determine more accurately how far HIV has progressed, and what treatment each patient requires. In 2011, MSF enrolled 10,720 people in HIV care, and some 5,420 patients started ARV treatment. Between July and December, 8,220 people were tested for HIV.
Reduced funding for healthcare
Despite significant advances in HIV care, many challenges remain. About 500,000, or roughly two-thirds, of all Mozambicans in need of ARVs do not have access to this lifesaving treatment.
Low government spending on healthcare and a reduction in international support have slowed the response considerably. In 2001, the government pledged to raise health spending to 15 percent of the budget. But it still falls far short of this level, at only seven percent, and the country is heavily reliant on donor funding. MSF will continue pushing for the scaling-up of quality treatment, despite funding constraints and administrative challenges.
At the end of 2011, MSF had 444 staff in Mozambique. MSF has been working in the country since 1984.