Delivering comprehensive safe, stigma-free HIV care in Namibia
By Valery Mwashekele
THE Key Populations-Strengthening Technical Assistance and Response for Sustainable HIV Prevention and Treatment (KP-STAR) project aims to increase access to HIV services for Key Populations (KPs)—men who have sex with men (MSM), Female sex workers (FSW) and transgender (TG) individuals in line with Namibia’s National Strategic Framework for HIV and AIDS Response (2017-2022). The goal of the project is to strengthen HIV prevention for key populations and other HIV KP programmes while scaling-up innovative, evidence-based approaches to reduce the incidence and mitigate the impact of HIV. The project operates in 10 districts within nine regions that have the highest prevalence of HIV and the largest numbers of key population members in Namibia. The implementation of the project started in April 2020.
KP-STAR is funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID). The project is implemented in partnership with the Ministry of Health and Social Services (MoHSS, Key Population-led civil society organisations including Rights not Rescue Trust (RnRT), Wings to Transcend Namibia Trust (WTTN), Voice of Hope Trust (VHT), Men Power Community Trust (MPower) and Sex Worker Empowerment Trust (SWET). Other partners are Walvis Bay Corridor Group (WBCG) and IntraHealth International. IntraHealth Namibia (IHN) provides overall leadership and management of the project. One of the three key components of the project is to strengthen the organisational and management capacity of KP-led organisations setting them at the centre of the national HIV response among KPs.
Peer Navigation: Increasing ART Initiation and Treatment Adherence
HIV service delivery has become increasingly challenging due to the COVID-19 pandemic. Restrictions to movement due to lock down and curfew meant that programme implementation had to adapt. As a result, KP-STAR teams have developed innovative ways through a virtual online platform to reach Key Populations, maintaining core HIV services, and supporting community engagement. The online platform called QuickRes allows clients to book appointments for health services in Namibia. This can be done from the comfort of your home or anywhere you access to your smart phone. Through QuickRes the project has continued to maintain contacts with existing clients while reaching new clients. This has facilitated uninterrupted access for essential HIV services such as HIV testing services including oral HIV self-test kits (HIVST), oral HIV pre-exposure prophylaxis (PrEP), refill for antiretroviral therapy (ARV) and screening for and treatment of sexually transmitted infections (STI). The easy-to-use platform not only makes it possible for clients to book health services online, but clients can also complete a quick health screening without the need to go to a health facility.
Over the past 12 months since the inception of the project, over 15,435 KPs have been reached with targeted and comprehensive HIV prevention interventions including risk reduction interventions. To expand bio-medical prevention intervention among KPs the project distributed over 2,715 condoms and 6,263 lubricants and supported over 3,709 KPs newly enrolled on PrEP. Condoms and PrEP are critical interventions and are part of the national Combination Prevention Strategy (CPS) to reduce new HIV infections among Namibians.
To rapidly support the MoHSS close the treatment coverage gap among KPs, the project has expanded HIV testing services. Between April 2020 and March 2021, the project identified 1,170 newly HIV positive KP clients and successfully linked 99% of them (1,154 out of 1,170 individuals) to lifesaving ART services. So far 1,154 KPs are active on ART. There has also been a significant increase in the number of new HIV diagnosis from 152 in the first quarter of implementation (April to June 2020) to 321 between January and March 2021. This achievement is due to the commitment of Peer Educators and Case Managers during a very difficult time of COVID-19.
Differentiated service delivery model through comprehensive case management of clients on ART has contributed to improved adherence and sustained suppressed viral load among KPs living with HIV. Between April 2020 and Dec 2020, the project recorded an increase in viral load suppression among clients on treatment from 73% to 95% – meaning those with a suppressed viral load can continue to have a healthy fulfilling life and cannot pass the virus on to their loved ones. This is a message of hope to others who live with HIV. It is the success that comes along with adherence, the victory after all those days when drugs felt like a burden. The project results are on average equal to the country’s general population suppression rate and are in line with the global UNAIDS 95-95-95 goal.
To promote the safety and well-being of staff and clients during the pandemic, the normal practice of community-based initiation of ART for Key Populations during outreach was stopped. It was instead replaced by the distribution of ART to Key Populations by lay providers, particularly Peer Educators. The ART-nurse coordinated model allows Peer Educators to collect drugs for small number of stable patients while they dispense medicines to their peers at home and provide psychosocial support, while observing all covid-19 protocols of hand hygiene, face covering and social distancing. The initiative helps to decongest the healthcare facilities and strengthens community support for KPs living with HIV. The different teams also identified drop-off locations and hotspots where clients could pick up commodities like condoms, lubricants, and HIV self-test kits.
The results are evident that strong Peer Educators and Case Managers are committed to improving the health of their clients.
“Relentless follow-up plays an important role in winning trust, even when clients are in denial about their HIV status. By showing up at the hotspot looking for them, sending a text message, or making a phone call just to say hello and finding out about their wellbeing, encourages my clients to stay on treatment and to go for routine follow-ups,” says a Peer Educator from Gobabis.
Brian says he was always feeling sick but did not care. “After long sessions of counselling and continuous follow-ups, my Case Manager convinced me and got me into the treatment program at a health facility. I’m now doing and feeling much better and would want to help my peers to join me on this self-care journey”.
Healing Light: Providing Health Services Free of Stigma and Discrimination
A key component of the project is to train health staff to provide services that are respectful, dignified, and free of stigma and discrimination. In collaboration with the MoHSS, the KP-STAR team held a series of online workshops for health workers who serve Key Populations in the ten districts. The trainings encouraged and enabled health workers to honour their oaths by treating all clients with dignity, respect, and care, with a focus on empathy. The health workers who showed willingness to provide more inclusive services and to share their newfound knowledge and skills with colleagues appreciated the workshops.
“Reading the oath made me realise that being a duty bearer is a lifestyle. I can’t wait to see my clients again, this time with a different perspective.” —Sister Andelisha Slinger, Registered Nurse, Walvis Bay Corridor Group.
Valery Mwashekele is a communication Specialist at IntraHeath Namibia.