Aside the mainstream healthcare delivery services and training of health staff, CHAG undertakes other programs as a Civil Society Organization with the aim of contributing to government’s efforts to attain the Universal Health Coverage and Health Security. One of such interventions is the HIV/TB Community Systems Strengthening (CSS) under the New Funding Model 3 (NFM3) of the Global Fund valued at $ 17.6 million.
CHAG was given the responsibility through a competitive bidding process to lead the implementation of the
CSS intervention from January 2021 to December 2023. Since January 1, 2021 CHAG has been implementing the program through peer-led HIV community service delivery and community-based organizations led TB case finding in hard-to -reach areas.
The Global Fund in July announced additional funding to mitigate the effects of COVID-19 on HIV/TB services. In this regard, CHAG was awarded additional funds to procure personal protective equipment (PPEs), roll out community interventions on infection prevention and control and to present a plan to mitigate intimate partner violence and gender-based
violence (IPV/GBV) due to COVID-19 and HIV/TB in Ghana.
There was an improvement in the percentage of HIV-positive women who received ART during pregnancy or labour and delivery (PMTCT-2.1). From 1 January 2021 to 30 June 2021, community cadres contributed in reaching only 691 clients. By December 2021, the number of positive pregnant women accessing treatment increased to 2,303 clients, totaling 2,994 clients receiving ART in 2021. This represents 63% coverage of the estimated 4,760 population and achievement of 76% of the annualized 2021 target. We anticipate that continued strengthening of the community cadres and collaboration with the Ghana Health Service will allow for improved performance in 2022.
Despite improved performance in reaching HIV positive women with ART, there is a challenge with follow up of index clients by community cadres. From 1 January 2021 to 30 June 2021, the facilities with community cadres reached 2,505 listed partners and children of HIV positive cases, representing 16% coverage of the 15,740-population estimate. By close of December 2021, the results showed an increase to 4,308 clients of the 15,740 population estimate, representing 27% coverage and 43% achievement of the target. This results in
22% coverage of the population for 2021 and achievement of 34% of the annualized target. The program is taking proactive steps with the Ghana Health Service, community members and partners to consider a community- based testing model that will effectively reach index clients, perform tests and link and support positive clients. Improvements were recorded in the percentage of people newly diagnosed with HIV initiated
on ART.
The Global Fund has through the HIV/TB CSS program prioritized interventions that seek to strengthen communities. Communities in this regard refer to people who are connected to each other in varied and distinct ways, such as people who are particularly affected by HIV, TB, and Malaria. The aim is to increase community participation, ownership, and accountability to achieve epidemic control including breaking down barriers to human rights.
The HIV/TB CSS broadly supports prevention of mother to child transmission of HIV (PMTCT), psychosocial support for populations living with HIV, TB case finding, reducing human rights related barriers to HIV/TB and community led monitoring, advocacy and feedback.
In 2021, a year after implementation, community cadres – peers living with HIV who support community HIV services – under the classification of Mentor Mothers (MM), Models of Hope(MoH), Community Adolescent Treatment Supporters (CATS) provided peer-to-peer support with the goal of contributing to the UNAIDS 95 -95 -95 targets for 2030. Also, a specialized group of cadres, Case Managers, who are not necessarily persons living with HIV, provide support to other community cadres to effectively deliver their tasks.
From 1 January 2021 to 30 June 2021, the program reported 7,729 clients linked to treatment of 11,569 newly diagnosed PLHIV, representing a 66% linkage to treatment rate. By close of December 2021, 11,567 of 14,275 clients were linked to treatment, representing an 81% linkage rate and 90% achievement of the target. While the linkage rate has improved, there are continued challenges with enforcing the national same-day treatment initiation guidance. The program recognizes community cadres’ unique position
to provide client support in linkage to treatment process in their facilities and will leverage it to optimize linkage rates. ART coverage in facilities with community cadres continue to increase. From 1 January 2021
to 30 June 2021, the program reported a 46% treatment coverage rate. By December 2021, 216,327 clients of estimated 330,495 PLHIV nationally were on ART. This represented a 65%treatment coverage rate for 2021 and 113% achievement of the target.
The CSS seeks to support the national efforts in promoting and strengthening an enabling environment to ensure that Ghanaians (community members) have access to HIV/TB prevention, treatment, care and support services. Stigma and discrimination issues still impact access to HIV services and staying on treatment. The program has rolled out stigma and discrimination reduction activities in health facilities and at the community level.
To increase awareness of human rights knowledge, access to services and resolution of human rights concerns in the HIV/TB community, Community Peer Paralegals (CPP) were designated to health facilities. By the close of December 2021, 120 CPP were trained and working in 136 facilities in 93 districts. The program aims to reach 160 health facilities with 160 CPPs in 2022.
A baseline assessment was carried out in 20 selected health facilities to determine the level of stigma and discrimination (S&D) in those facilities. The results indicated that though S&D occurs in the facility, much of it occurs in the home/community. Health care workers (HCWs) from the selected facilities were trained in reducing S&D against PLHIV/TB. By the end of the year under review, about 950 HCWs and community members have been trained. Religious leaders were also engaged to support the reduction of S&D against persons living with HIV/TB. A half-day sensitization with them took place in Tamale, Koforidua, Sunyani,
Cape Coast and Obuasi.
When I returned to my facility after my first training. I met with my team at the facility level to solve some challenges such as low ANC attendance since it was established. So we had to sit up. We lobbied for new critical staff, held some community durbars to engage with the community. We then provided equipment needed for ANC services, ensured medicines supplies, directional sign boards, established ANC access points in the community. We engaged with the management to provide means of transportation such as motorbikes so staff can reach mothers who are very far away and could not afford. We have since recorded more than 16% increase at the ANC. All this have been possible through the training received from the CHAG/FCDO program.
I participated in the first QI training and after a few months we have been able to improve attendance at the OPD which was very low before the training. We did this through team work and engaging with our community. We have since seen some increase in attendance of about 15% which is a major improvement. All thanks to the CHAG/FCD training on the Quality Improvement, we are very grateful.
It has been beneficial attending the QI training. At my facility we realized hand washing/ hand hygiene was not being practiced well. So, we used strategies learnt to ensure that both the staff and client ensure that hand washing was always practiced; we trained our colleagues, and remained everyone, printed protocols and created more hand washing bases so it was easier to access them for both staff and clients. We also have a new tank to store water so there is no excuse for “no water”. We now have the inscription “No handwashing no entry”. We have assigned staff to ensure this is always done and always give feedback. Many lives definitely have been saved by this simple act of handwashing.