Class instructor and Student. Photo by Brian Donnelly
CHS and its affiliate, University Research Co., LLC (URC), support countries in Africa, Asia, Eastern Europe, and Latin and North America to develop HIV programs that focus on creating better health outcomes for underserved and vulnerable populations. We apply methods that are locally adapted and country led to improve health care systems. Working with local health care providers, community leaders, patient advocates, and government officials, we identify gaps in service delivery processes, then develop and expand best practices to achieve sustainable improvements. Our programs are designed to advance the US Global Health Initiative objective of creating an AIDS-free generation and encompass the areas described below.
CHS’s efforts to prevent HIV transmission include behavioral, medical, and environmental components: preventing transmission of infections, reducing risky behaviors, increasing counseling and testing, and fostering an environment free of discrimination and stigma. We assist health systems in strengthening the continuum of care for the prevention of mother-to-child transmission of HIV. That continuum is a comprehensive, interconnected array of services that includes prevention, treatment, and care for pregnant women and their infants during pregnancy, labor, delivery, and beyond.
We work closely with facilities to empower health care providers to provide high-quality, patient-specific, and comprehensive HIV counseling combined with accurate and reliable testing. We help health systems create and/or strengthen links between HIV and other health services for provider-initiated counseling and testing. We also work with community groups to reach individuals for voluntary counseling and testing.
Care and Treatment
CHS and URC work with treatment centers to reach, retain, and achieve better outcomes for people living with HIV. For example, URC’s Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) project supports 17 Ugandan hospitals that have provided comprehensive HIV services to more than 45,000 HIV-positive adults and children. The project helped the hospitals reach and retain in antiretroviral therapy (ART) nearly 34,000 patients and link them to preventive services. In the first quarter of 2012, the hospitals prescribed preventive medicines to 93% of these patients.
We also work to integrate HIV and TB prevention, counseling and testing, and care and treatment services. For example, within two years, URC’s TB South Africa project increased TB screening among HIV-positive patients from about 75% to nearly 97%, and it increased HIV counseling and testing among TB patients from 76% to 92%.
Community-based Care and Support
CHS and URC engage communities to provide ongoing care and support for people living with HIV and AIDS. Through the HIV and AIDS Comprehensive Care Initiative (HACCI), we partnered with a local organization, Women for Women International, to reach women in rural Nigeria. HACCI discussed issues surrounding HIV/AIDS with groups of women who meet regularly through Women for Women and offered them voluntary counseling and testing. Three outreach campaigns reached more than 400 women in one community in Enugu.
Vulnerable Children and Families
Due to the long-term effects of HIV/AIDS and poverty, many countries, particularly those in Africa, are home to large numbers of children living either without the support of a caring family or in a family struggling to meet their children’s needs. These children are considered vulnerable—they are more likely to be exposed to violence, exploitation, abuse, and neglect—and subsequently are at greater risk of poor health, including HIV/AIDS infection. URC is working to improve the well-being of vulnerable children and families.
Health Workforce Development
High-quality HIV services depend on a competent, efficient health workforce. However, countries with a high HIV burden often lack the health workforce required to provide basic health care. Many health workers experience tremendous strain due a multitude of factors that vary by contexts and include a high volume of patients and frustrations related to working in a weak health system. These factors can result in low morale, absenteeism, poor retention, and high staff turnover.
CHS evaluated a cost-effective method to build capacity among non-physician clinicians in sub-Saharan Africa for the treatment and prevention of infectious diseases, including HIV/AIDS. A comprehensive surveillance system of 36 health facilities and their patients measured the impact of a novel package of classroom training, distance learning, and on-site support services. The measurements examined changes in the levels of individual competence, facility performance, and health outcomes that resulted from implementing the package. The following figure shows the measurement of facilities’ performance in providing triage for patients arriving with emergency care needs.
In low-resource settings, inaccessible or unreliable lab support and infrastructure can diminish the quality of health services. CHS seeks to build and improve health systems’ capacity to provide lab support through accreditation; facility renovations; and on-site training in bio-safety, documenting standard operating procedures, and equipment maintenance. We also facilitate in-country training for national and regional labs and lower level facilities.
Health Management Information Systems
Organized, well-maintained records are critical in providing efficient and informed care as well as for developing and testing changes to improve care. Our activities frequently begin with a focus on improving documentation and data collection practices.