Community Health Workers: The True Heroes of HIV Self Testing

Posted juillet 6, 2016

Justin Matheson-Turner, Intern

The UNITAID/PSI Self-Test AfRica (STAR) consortium were joined by members of the Ministries of Health from Zimbabwe, Zambia and Malawi, as well as PSI Global Ambassador Debra Messing, last week in Blantyre, Malawi. The team learned firsthand how making HIV testing easier and more accessible can lead to getting people on treatment sooner.

They met with village leaders, as well as couples and individuals testing themselves for the very first time. However, it was clear that the community health workers who go door to door to offer HIV self-testing kits are vital to the success of PSI’s STAR program.

Vileta shows Rhoda how to do #HIV #selftest & get results in 20 mns. Part of #UNITAID #PSI program in #Malawi pic.twitter.com/0WuS3QHVpu

— Unitaid (@UNITAID) June 27, 2016

Community distributor Vileta earns the trust of villagers like Rhoda because she offers HIV self test kits that are affordable — often free — and easy-to-use. She also explains exactly what comes next if Rhoda were to test positive and how she can get linked to care near her. Rhoda will have this information whether she chooses to test with Vileta or after Vileta leaves Rhoda’s home.

.@DebraMessing with distributors of #HIV #selftest kits in Chifunga #Malawi, a project funded by us w/ #PSI pic.twitter.com/PAk0pyQhZn

— Unitaid (@UNITAID) June 27, 2016

Less than 50% of all people living with HIV are aware of their status. Community-based distributors are not only distributing HIV self-testing kits, but also gathering the information needed to make sure that when STAR partners, like the World Health Organization, expand the effort it’s effective, ethical and efficient.

Robert Matiru & @DebraMessing took an #HIV self test with Gilbert & Matilda in rural #Malawi #HIVselftest pic.twitter.com/JOLcFugg3Z

— Unitaid (@UNITAID) June 28, 2016

Matilda’s husband Gilbert just had his first HIV test, which he administered himself, without a needle. Community-based distributors shared with Debra Messing and UNITAID’s Robert Matiru that men often won’t go to a clinic given how long it takes to walk there, the stigma of getting tested for HIV and the shame they feel standing in line with women. By providing home-based HIV tests the STAR project gives people another way to know their status and we help overcome many of the barriers that keep people from getting tested in clinics.

.@DebraMessing talking with women in #Malawi – AIDS free generation is within reach thanks to @PEPFAR @GHDatState pic.twitter.com/ZCUwKX1SEQ

— Marshall Stowell (@IntentionalMS) June 27, 2016

Adolescent girls and young women are often stigmatized if they go to a clinic to get tested for HIV. Testing privately helps overcome obstacles even beyond stigma and discrimination, including policies such as “age of consent” laws, cost of seeking services, long lines, lack of privacy and confidentiality, and reports of poor quality HIV testing. Bringing the opportunity to test in the place and time of her choice can help lead to an AIDS-free generation.

https://www.instagram.com/p/BHXKKxJD479/?taken-by=jillfilipovic&hl=en

“Universal truths are rare, but at least in my experience, one of them is that community health workers (midwives, nurses, peer educators) are some of the baddest broads in any country.” —@jillfilipovic

https://www.instagram.com/p/BHVFK2wjky_/?taken-by=jillfilipovic&hl=en

Between now and 2017, the STAR project will distribute nearly 750,000 HIV self-test kits in sub-Saharan Africa. Supporting a comprehensive approach that includes HIV self-testing gets people on treatment faster so we can reach the UN’s 90/90/90 goal. When we remove the barriers stopping people from knowing their HIV status, we help fast track treatment, reduce stigma and enable people to live healthy and productive lives.

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

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In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.

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In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.

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Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

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Here’s what it looks like in practice.

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Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.

Community Health Workers: The True Heroes of HIV Self Testing

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

Engaging the private sector for disease surveillance in Myanmar

Training health workers in Angola

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