Five Ways Health Care Workers are Improving HIV Services for their Community in Malawi

Despite Malawi’s success in expanding HIV prevention, care, and treatment services, the proportion of people living with HIV who know their HIV status is only 53%; well below the 90% target set in the country’s Strategic Plan for HIV and AIDS. Malawi aims to meet the ambitious 90-90-90 targets released by UNAIDS in 2014.

To reach the target of diagnosing all (or at least 90% of) people living with HIV, Malawi is scaling up provider-initiated testing and counseling (PITC).

In order to meet facilities’ needs for more staff dedicated to HIV testing and treatment services, Malawi organized a small group of lay citizens to be trained as HIV diagnostic assistants (HDAs) to focus on PITC, identification of people living with HIV, and linkages to care and treatment.

With funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention (CDC), EGPAF-Malawi engaged two local organizations, Lighthouse, and the Malawi AIDS Counseling and Resource Organization (MACRO), to recruit, train, and deploy 164 HDAs to 63 priority health facilities in seven districts.

HDAs provide HIV testing and counseling at health facilities, but at Ekwendeni Community Hospital, HDAs are exceeding their duties to enhance HIV services for their clients. Here are five ways that HIV diagnostic assistants at Ekwendeni Community Hospital are helping to end AIDS:

1. Diagnosing Mothers

With the help of HDAs, Ekwendeni Community Hospital increased HIV testing services at the antenatal care (ANC) clinic for pregnant mothers by 184%.  Ekwendeni tested 1,841 women at ANC from January to June 2016, almost twice as many as were tested during that same time period in 2015. Olipher Nkhata, a then mother of two, was pregnant with twins when she was offered an HIV test at her antenatal appointment. She tested positive, and was started on antiretroviral therapy (ART) that same day.  

2. Ensuring Supplies are Always Available

Stock-outs, or times when HIV testing supplies run out at a facility, can be a common occurrence.  Through the use of a daily activity register, HDAs track supplies used each day, keeping facility drug store in-charge informed of when supplies are running low and reorder from drug store. 

3. Reaching More Clients with HIV Testing and Counseling Services

After the introduction of HDAs at Ekwendeni Community Hospital, 230% more clients received services from January to June 2016 compared to the same time last year. The availability of HIV testing in multiple wards means sick patients do not have to go far to receive services, like Agness Moyo who was tested for HIV by HDA, Joshua Ngulube, when she was admitted into the female ward for feeling ill. Her mother died from AIDS-related illnesses and her father had been on ART, but at 20 years old, Agness had never been tested for HIV. Joshua tested Agness, and learned that she, like her father, was living with HIV. With emotional support and encouragement from Joshua and her aunt, Agness started ART and is now beginning to accept her status.

4. Linking Youth to Services

Ekwendeni Community Hospital has two active youth clubs, both clubs meet once a month and have about 50 members each.  Topics discussed amongst youth each month include: psychosocial support techniques, goal setting, nutrition, drug adherence, and reproductive health. In addition to offering testing services at the hospital, HDA Joshua Ngulube also coordinates both clubs.  He advocates for his clients, like Agness, to participate in the clubs as a way to gain knowledge and acceptance of their status amongst peers.

5. Providing Peer Support for Community Members

HIV positive clients often admit to HDAs that health facilities can be intimidating due to stigma against people who are sick. HDAs are normally from the communities in which they work, and their familiarity with clients makes them more approachable. HDA Victor Kaluwa explains that through his work at the health facility he communicates to peers that spending time with a person who is HIV-positive “doesn’t mean you’re exposed.” Victor makes a point of visiting and sharing meals with his clients. His congenial attitude in and out of the hospital makes him accessible to his clients, opening the facility doors to those otherwise fearful of pursuing HIV testing and counseling services.

Robert Mogha, Health Management Information Systems Officer at EGPAF-Malawi, works to monitor the success of the HDA program.  He says, “Since introducing HDAs to EGPAF facilities, we have seen a significant increase of the number of mothers attending the clinics and those identified as HIV-positive. HDAs have become a crucial facet to helping Malawi reach our first 90 target, and we couldn’t achieve it without them.”