Over the past decade, increasing numbers of people with HIV have gained access to antiretroviral therapies. Last year around 18.2 million people in developing nations alone accessed the life-saving medicines. But there are still millions of people who find accessing this therapy difficult.
“If people are in rural Africa and they have to travel to the clinic for pills, there are lots of issues. Perhaps they have to travel all day, then there’s the money for the bus, and they lose a day’s work. They have to leave the family behind, which is especially a problem for women with children,” says Anton Pozniak, HIV consultant at the Chelsea and Westminster hospital in London.
“When they are feeling really well, the motivation to do this can be diminished,” he continues.
Millions of people do not even know they are living with HIV, because they haven’t been tested. This can cause HIV prevalence in the area in which they live to continue to increase.
Reaching rural communities
Responding to this challenge in 2015, Gilead, in collaboration with The Vatican’s Good Samaritan Foundation and other Catholic NGOs, launched an HIV test and treat in Shinyanga, northern Tanzania. Rates of HIV in the area are around 7%, according to the Ministry of Health. A largely rural place, most of Shinyanga’s inhabitants live on subsistence farming. The aim of the project is to bring treatment to the people – rather than the other way round – and test 300,000 and refer up to 20,000 onto treatment.
Gilead is committed to providing support – funding for medicines and diagnostics, staffing, and several infrastructure projects – for the project over an initial five year period.
Anand Reddi, public health and medical affairs at Gilead, is helping co-ordinate this project.
“If we can demonstrate the effectiveness of the test and treat approach in a severely resource-limited setting, and demonstrate bona fide outcomes and cost efficiencies, we can potentially replicate this model around the world,” he says.
In the first phase of the project, the team worked on establishing a central regional hub for HIV specialist services. A hospital wing, a laboratory, a pharmacy and several clinics were also built.
Now the project is being expanded using a hub-and-spoke system. Hub clinics will have healthcare workers, laboratories and in-patient care. The hubs will also have spokes: mobile clinics that will go into rural communities. The testing and initiation of HIV treatment will also take place in the mobile clinics to foster decentralised care.
Collaborating with the Catholic church
The Catholic church – and in particular the progressive leadership of the Bishop of Shinyanga – is key to the success of the project.
A qualified nurse and midwife, Sister Kate, of the Missionary Sisters of Our Lady of Apostles, is coordinator for the continuous care and treatment services at Bugisi health centre, Shinyanga.
“[The project] has made an impact on so many people in Bugisi and surrounding villages. It’s the ripple effect of this test and treat project that touches the lives of so many.” She says that more than 600 people have been referred to continuous care and treatment over the past year, and there are currently 2,538 people on treatment at the Bugisi health centre.
Pozniak is the project’s principal investigator; he also chairs the implementation and research group. He says that people in the area are already fairly aware of HIV, thanks to the government, which is committed to providing treatment for everyone with the virus.
As the project develops, HIV specialists will be established in the central hospital, or hub, with health workers in more local clinics. People whose HIV has been treated for more than a year may start to use “clubs”. They’ll visit a clinic-based nurse every three, then six, months, and then once a year for check-ups. Health-workers – or volunteers from a user’s club – will collect drugs for HIV treatment from a central hub so that they are available locally, and disruption to individuals’ lives is minimised. This element is in its early stages, but Pozniak is hopeful that it will work.
According to Pozniak: “After five years, we hope that this project will be sustainable - the structure will be in place. In [the] meantime, there will be more test and treat facilities. Also, by employing local people [as health workers and coordinators], there will be a positive impact on the local economy.”
This is not the only project that works on delivering care to remote communities in rural Africa. However, this is the first of its type in Tanzania.
Reddi says: “Gilead recognises that in addition to developing new drugs we also need to develop new models to deliver care in resource limited settings. It’s not just enough to treat patients, we also need to innovate the models of care that enable patients to access our medicines.”
Content on this page is paid for and produced to a brief agreed by Gilead, a sponsor of the Guardian’s Global Development Professionals Network.
Date of preparation: April 2017 (HIV/IHQ/17-03//1363c)
