The battle to beat AIDS

FOR the past 10years, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been working tirelessly through the United States Agency for International Development (USAID) to strengthen Papua New Guinea’s response to HIV. With funding from USAID, FHI 360 implemented the Strengthening HIV/AIDS Services for Key Populations in PNG Programme from October 2012 until September of this year, aiming to reduce HIV incidence among key populations, their partners and their families.
The programme focused not only on creating demand and improving the quality and supply of HIV/AIDS services – including condom and lubricant use, harm reduction, HIV counseling and testing, sexually transmitted infection, case management and antiretroviral therapy (ART) – but also on improving the screening for gender-based violence (GBV) and providing services to GBV survivors, as well as building the capacity of government and nongovernmental organizations in monitoring and evaluation.
Since the inception of the programme, HIV testing has increased, signifying that more people are seeking to know their HIV status, and more people are enrolled in HIV treatment, while HIV-related deaths have decreased.
The ongoing commitment, support and efforts of the PNG Government and local partners were crucial to the achievement of these results.
The ultimate goal of the programme was not only to reach and aid key populations but also to empower local health authorities to reach and assist these populations, working closely with local partners and non-governmental organisations, including the Salvation Army, Living Light Health Services, Voluntary Services Overseas, the Family and Sexual Violence Action Committee, the Modilon General Hospital and People Living with Higher Aims.
FHI 360 developed various training programmes and tools to strengthen the capacity of local agencies to provide key populations with HIV and GBV prevention, care and support.
By virtue of the strong partnership with these local partners, the handover of key interventions to provincial health authorities in Madang has been a success.
The Strengthening HIV/AIDS Services for Key Populations in PNG Programme implemented a compendium of interventions to increase the number of key population members reached and tested.
Over the six years, strategies were adapted, and new interventions introduced to provide timely and appropriate services.
Using a model known as the Enhanced Outreach Approach, the programme successfully reached over 14,000 key population members in Madang and National Capital District (NCD), including female sex workers, men who have sex with men and transgender people, with a minimum HIV prevention package.
About 11,000 other high-risk men and women were also reached with the prevention package.
Ensuring as many key population members as possible know their HIV status is pivotal in providing appropriate services and curbing the spread of HIV. The program introduced the “4-3-2” and “5-4-3” strategies, aimed at increasing outreach to key populations, referral to health facilities and the number of key population members who are testing and know their HIV status.
These strategies ensure that a minimum number of key populations are reached with a package of preventive interventions, and supported to access HIV testing services by peer educators each week. Using these approaches, the proportion of key population members successfully referred for HIV services increased from 4.5 percent in 2016 to an impressive 62 percent in mid-2018.
Overall, more than 28,000 individuals received HIV testing services through direct support from the Program, with 1,417 people living with HIV identified and enrolled into the HIV care and treatment programme in Madang and NCD.
In both provinces, the program expanded and improved clinical services for key population and their families at five clinics with funding from PEPFAR through USAID.
The programme built the capacity of health care workers, provided computers for data collection and reporting, and procured essential clinical equipment and consumables in seven health facilities in the NCD.
In collaboration with the Health department, World Health Organization, Global Fund, Oil Search Foundation, Madang Provincial Health Office and National Capital District Health Services, the programme, led by FHI 360, also trained clinicians to ensure that the services offered are thorough, well-documented and conducted with the utmost sensitivity to the specific situation and populations.
Gender based violence (GBV) is one of the leading risk factors for HIV infection.
A critical aspect of the programme therefore involved reaching populations subject to gender base violence. Besides community-based gender awareness training to community and church groups, FHI 360 introduced the integration of gender-based violence services in HIV and Sexually Transmitted Infection clinics.
Utilising and expanding on existing services, the integration was successful in making gender-based violence services accessible to the community and enabled easy access to time-sensitive services such as psychological first aid support, post-exposure prophylaxis, sexually transmitted infection prophylaxis, emergency contraception and vaccination against tetanus and hepatitis B for survivors of rape and other forms of sexual violence. Through this integrated model, the programme successfully increased uptake of post-gender-based violence clinical care among gender-based violence survivors from 41 percent in 2015 to 98 percent by mid-2018.
FHI 360 and its partners also provided shelter services for GBV survivors and their children at the Haus of Hope and Meri Seif Place in Port Moresby. As part of the Program, Child Fund, the Family and Sexual Violence Action Committee and FHI 360 introduced a toll-free phone counseling service that operates from 7am to 7pm, seven days a week.
This initiative has proved a success: 3,000 of nearly 5,000 people who phoned in were referred to some service.
FHI 360, in collaboration with the Health department, Centre for Disease Control, World Health Organization and National Capital District Health Services, implemented health system strengthening initiatives through technical assistance that covered the organizational capacity of NCD Health Services and seven health facilities in NCD.
It also supported the rollout of viral load services to nine clinics and initiated ART services at Gerehu and Tokarara clinics, increasing the number of clinics with ART services in NCD to 10.
The feedback collected demonstrates that clinicians, government officials and local partners were pleased with the training and assistance provided by FHI 360.
The topics covered were relevant to the current situation of PNG, and the training provided them with opportunities for professional growth.
Many of the clinicians felt that ongoing participation of FHI 360 would strongly benefit the country. Technical assistance also contributed significantly to the overall success of the programme.
In only two years, the proportion of expected reports submitted on time by HIV clinics in National Capital District increased from 15 percent to nearly 88 percent.
Despite facing numerous challenges and barriers, this USAID-funded programme achieved several important goals and milestones in strengthening PNG’s response to HIV, as well as drawing valuable lessons for future programmes and initiatives.
One of the most valuable takeaways from the programme was the necessity for consistent adaptation of intervention toward key populations and communities.
Key populations seem to be constantly on the move. In order to maximize outreach, peer educators need to be able to adapt to the changing environments. Based on the outcomes of the programme, leveraging social media and setting up more mobile clinics are fundamental actions that need to be taken to locate and reach more key population members. Furthermore, adding a wider range of peer educators to the existing team would increase the chances of reaching the small pockets of key populations that have not been reached so far.
Through USAID support, The Strengthening HIV/AIDS Services for Key Populations in PNG programme has achieved remarkable results in increasing awareness of GBV and reducing stigma and discrimination.
Continued mentoring and sensitization of staff would further improve the conditions of health care for key populations, and creating more mobile clinics may be one way to reach more key population members due to the anonymity these clinics offer. Several stakeholders have acknowledged the significance of achievements from this program, and the Government of PNG has praised USAID and FHI 360 for their contributions to the national response to HIV.
Many partners expressed an eagerness to continue working alongside FHI 360 in the future, and the Government proposed that USAID and FHI 360 should scale up such programme s to reach more provinces.