Lita was readmitted to Nsanje District Hospital in October with a fever, bloated stomach, and leg swelling. This time, her father is determined to make sure his daughter follows her treatment program. “It will not happen again, as I will be around,” says her father, Gerrald. “I will be there making sure that when she wakes up, I am there, and she takes her drugs. The same with the evening dose, I will make sure that before she goes to sleep, she has taken her drugs.”
Not many days ago, Lita was unable to walk without support. Now she is feeling better, but she misses her three-year-old daughter. The next step for Gerrald is to get his granddaughter tested as well. “I want to bring her here for testing so that we get to know her status – if she is HIV positive or negative,” he says.
Working with the community to help people with HIV
The circle of care starts at the community level. In Nsanje district, MSF community health workers coordinate with traditional authorities, patient groups, and local associations to reinforce existing community structures and identify those who are sick and need more care. They also help raise community awareness of the symptoms and danger signs.
“Previously, most HIV/TB [tuberculosis] activities were done at a health facility level and not much in the communities. As a result, people who defaulted [from treatment] had no proper follow-up,” explains Moses Luhanga, information and education manager.
When someone is identified as requiring further treatment, they are then referred to a nearby health center. In Nsanje, MSF, working with the Ministry of Health, has instituted a package of care which begins with a very quick assessment and some tests: CrAG for cryptococcal meningitis, a CD4 count, and a test of blood sugar levels and urine. If the patient has a condition requiring advanced management, they are referred to the district hospital.
"I want to be the voice of change"
Back at the hospital, Austin is getting ready to be discharged. He and his wife are carefully wrapping up their belongings in chitenges, brilliantly colored fabrics used in Malawi. After 12 days at the hospital, they are happy to go home.
To make sure that Austin and other HIV positive patients being discharged stick to their treatment programs and don’t get advanced HIV, MSF has a post-discharge procedure involving visits from the counselors. Although Nsanje district is close to meeting the 90-90-90 targets, the next challenge will be to make sure people on HIV medication continue their treatment and receive quality care if they fall sick.
Getting people to know their status and start the treatment are steps in the right direction. Before the circle of care was implemented in the district, statistics from Nsanje district hospital indicated that 27 percent of people entering the hospital with advanced HIV would die. But since the system was implemented, there has been a gradual reduction in the mortality rate of hospitalized patients with advanced HIV; over the last year, the mortality rate was under 15 percent.
For people like Austin, getting the care he needed not only made him well, it also inspired him to make sure other people who are HIV positive get to know their status, and then start and stay on the lifesaving treatment.
“I want to be the voice of change in my community. I want to find people who are suffering from HIV and change this community to be disease-free,” says Austin. “After being looked after, I cannot just stand here while someone is suffering.”