Training Aims to Strengthen HIV/AIDS Response in Greater Equatoria Region

Apr 18, 2016

Nursing cohort of IMAI trainees receive instruction on HIV/AIDS treatment and care at Juba Regency Hotel on Wednesday, April 13, 2016. Photo Credit: UNDP

With an estimated population of 176,132 people living with HIV in South Sudan, only 19,481, or about 11%, of cases have been identified and/or treated according to the 2015 South Sudan Global AIDS Response Progress Report. The goal of the Global Fund to fight AIDS, TB and Malaria (GFATM) is to address this gap and reduce new adult HIV infections by 50%. One approach deployed in Juba in April was a two-week training of medical staff for new treatment centers planned to launch in the Greater Equatoria region.

“In the long run we want to improve the quality of life for those living with HIV and reduce the transmission of the disease,” said WHO HIV/AIDS Professional Officer Dr. David Lukudu.

“The estimates change [for the worse] every year but we hope with more centers, it will be possible to serve more HIV patients with the best treatment and improve their quality of life in line with the vision of the Ministry of Health,” he said.

The training focused on capacity building for 10 new antiretroviral therapy sites in the Greater Equatoria region. Following the establishment of the first round of clinics, there will be additional assessments and workshops for Greater Bar el Ghazal region, followed by Greater Upper Nile region.

“The lessons taught [in the training] will help South Sudan to fight HIV/AIDS in the states by increasing access to quality HIV care and treatment,” said UNDP Global Fund HIV Program Specialist Esther Itorong.

The two-week workshop included modules on treatment care and support to HIV-positive patients; antiretroviral therapy (ART) and treatment monitoring; Pre-ART care and opportunistic infections management; HIV testing and counselling for vulnerable populations; TB and HIV collaborative activities; and health system and health work strengthening. Each proposed new clinic site will ideally have a clinician, a nurse, a pharmacist, a counselor, and a data clerk, with an emphasis on the dynamic among them in the course through a focus on teamwork and collaboration.

“Our training is based on teamwork and as much as possible we try to give them knowledge and skills depending on the role they will play on the team,” said WHO consultant and lead instructor of the training, Dr. Yahaya Senyonjo.

Towards the end of the training each group huddled together to come up with operational work plans for their new centers.

“We want [the participants] to plan things that are within their reach and feasible,” continued Dr. Senyonjo. “The collaboration between the Ministry of Health, UNDP, and WHO has been very useful right from the beginning. We are able to know what each institution can provide in terms of support and resources. This helps the teams ground their plans in what is feasible.”

As well as receiving instruction and practical training in their focus areas of expertise, groups were formed for each proposed center with a balanced distribution of specialists for each role.

“HIV care is teamwork, really,” said Dr. Lukudu. “We are realistic that people who go to the [field] may have to play multiple roles.”

A major component of the training focused on more traditionally-viewed “soft skills” for the health workers to aid in establishing rapport with their communities and successfully providing effective one-on-one patient support.

“The last six chapters of the training manual focuses on connecting with the community. How do you reach out to people? How do you ensure patients return to the clinics? Sometimes people show up and disappear,” said James Ayieny, an HIV/AIDS Mentor from the HIV/AIDS Department of the Ministry of Health. “We try to use a crosscutting approach to instruct the trainees on the stigma and discrimination related to treating HIV.”

Beyond the training materials and discussion sessions, there are practical components in the training that stress anti-stigmatization principles. The most unique technique employed relies on the presence and role of Expert Patient Trainers. These trainers are real patients living with HIV, who led trainees through interactive role-playing scenarios. Participants also visited the Juba Teaching Hospital where the Expert Patient Trainers are employed in health support roles.

“They are able to see how much the patients can contribute to their care, that their clients can live with the disease and still have capacities to contribute to their treatment,” said Dr. Senyonjo.

“[Working with the Expert Patient Trainers] we were tasked with how to greet and get information from patients. They were able to give us feedback and we learned various ways to handle situations,” said Clinical Officer and session participant Dr. Patrick Hakim. “The skill sessions with the real life scenarios were most helpful. We were able to hear from various views and experience difference cases we may face in the field.”

The training was implemented and led by the Ministry of Health, who reiterated the commitment of the Government of South Sudan to expanding HIV/AIDS support and expertise beyond the nation’s capital.

“We are still far from reporting good news in scaling up our response to the HIV epidemic but our aim for this training is to make the sites functioning and committed to working with the community,” said Mr. Ayieny. “We expect more people enrolled in treatment programs focused on reducing pain and reducing infection.”

Trainees expressed satisfaction with the time spent in the training and the lessons they aim to implement in their practicing areas.

“Now I feel better prepared to go back to work where I may be able to share knowledge and mentor others,” said Dr. Hakim. “For example, I learned how to fill out the HIV Care Cards we use more comprehensively. I hope to take that back with me.”

The next steps for the teams will be deploying out to their clinic locations in the Greater Equatoria region. With continued support from the Ministry of Health, UNDP, and WHO, they will assess, establish, and evaluate HIV support programs.

“We will be there with the trainees every step of the way and ready to start addressing the realities of the clinical needs at a programmatic level in the communities,” said Mr. Ayieny.

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