The health community in the Western Pacific is adapting to make sure vulnerable populations are not left behind
The COVID-19 pandemic currently sweeping the globe is threatening to derail hard-won gains on HIV, tuberculosis (TB) and malaria, seriously impacting health programmes and causing disruptions to life saving treatment.
In these unprecedented times, national partners of HIV, TB and malaria projects in the Western Pacific, supported by the Global Fund, are adapting and implementing new strategies to ensure vulnerable communities continue to receive the health services and support they need.
Here are four of their stories:
Persevering to reach men who have sex with men and transgender people
“I am fortunate enough to be part of a medical community in Samoa that was very aware of the COVID-19 crisis in Wuhan and I have been monitoring its progress since early December,” said Mathew Amituanai.
Mathew is a clinician at a private health centre in Apia and runs an outreach programme known as the MSM Thrive Initiative, which provides HIV and sexually transmitted infections (STIs) testing and counselling for men who have sex with men and transgender people. The initiative is supported through one of UNDP’s national partners, the Samoa Family Health Association (SFHA).
Early in the pandemic, he realized that the continuation of vital sexual health services for marginalized people depended entirely on effective strategic planning.
“I had no doubt that a lockdown here would provide opportunity for increased sexual activities amongst people,” he said. “No one can really monitor what happens in a village and predictably, men who have sex with men, especially the young ones, were reaching out for condoms, lubricants and the chance to be tested and treated.”
The approach he devised was simple: risk stratification in strict compliance with the Government’s regulations.
“The high-risk group comprised of those with flu-like symptoms within the past 14 days and those with travel history, or contact with individuals with a travel history. For these individuals, I made no physical contact. Instead, we caught up using video calls, regular calls and messaging on social media.”
Prevention packages containing brochures, condoms and lubricants were dropped off at agreed locations to avoid physical contact.
The low risk group were people with no history of travel, no contact with those who did and no flu-like symptoms in the last 14 days.
“Every participant was given a mask and had their temperatures taken with an infrared thermometer as an extra precaution before being tested and counselled, while I wore full personal protective gear (PPE), and cleaned and sanitized everything,” he explained.
By chance, Mathew had a ready supply of basic PPE, including N-95 masks, medical gowns, gloves, hand sanitizers and disinfectants. “We recently went through a measles outbreak, in November 2019, so we had a stock already of PPE.” He also managed to source additional supplies, “I am thankful to my friends and family here and overseas for their donations and help in shipping supplies across.”
Participants were gathered in groups of three, with strict social distancing instructions, after which they were dropped off and another three were picked up.
“Public transport was an issue as it was banned, forcing participants to be picked up, but it worked out well in terms of controlling the flow in and out of our outreach site,” he said.
In the end, the programme reached 60 individuals, a number that is frustratingly lower than the typical 100+ people reached per activity.
“I believe it has been a success,” said Mathew. “Many issues close to my heart were unpacked here. We learned a lot about how events can drive increased unprotected sexual activities/STIs, fears that people are experiencing in accessing centralized medical services, violence at home and suicidal ideation. Such things only motivate me to do more, do better and be better. We can always find a way to reach people in need and for those of us who do this kind of work — the onus is on us to find the way.”
Federated States of Micronesia, Chuuk
The new normal: one-on-one outreach
“The coronavirus (COVID-19) is affecting everyone, from super-powers to the tiniest islands on the planet,” said Sincera Fritz, Key Populations Coordinator at Chuuk Women’s Council. “Our way of life and working has changed. Gatherings are discouraged and social distancing is now the norm.”
Indeed, the new normal is having profound impacts on how the Chuuk Women’s Council can do its work.
A partner of the Western Pacific Multi-Country Integrated HIV/TB Programme, Chuuk Women’s Council works with the Federated States of Micronesia (FSM) Health and Social Services to provide outreach services for vulnerable and key populations. The services provided include HIV and sexual health awareness raising activities, distribution of prevention packages of lubricants and condoms, and community-based testing and counselling for men who have sex with men, transgender people, female sex workers and youths.
The activities are conducted throughout the main island of Weno and the other islands of Chuuk State.
Typically, outreach activities are conducted in group settings, but due to new public health regulations, a new approach was needed to ensure the Chuuk Women’s Council was still able to provide HIV/ STI services to the population in need.
“Our key populations project had to change from group outreach to one-on-one,” explained Sincera, who also represents the Chuuk Women’s Council on the Chuuk COVID-19 Task Force Committee on Education and Awareness. “This is the first time this approach is being put to the test.”
From 27 April to 4 May 2020, the one-on-one outreach approach was trialed on Weno island. Over the eight day period, 61 people were reached, considerably more than the target number of 25. All of the individuals received HIV prevention packages and 57 out of 61 were tested for HIV and syphilis using rapid point-of-care tests.
One of the key elements of the approach was to use a large sports utility vehicle (SUV) as a mobile office/outreach clinic.
“We were able to come to them, instead of them coming to us,” said Sincera. “People expressed their appreciation for the convenience that this one-on-one outreach offers.”
“The mobile outreach clinic really was a great idea — it allowed us to load all of our papers, test kits and incentives into the roomy back of the SUV and stay in the field all day, including weekends and after working hours.”
With smaller groups, they also found that clients were more comfortable to open up and talk about their issues and struggles.
During the one-on-one sessions, Sincera and her team took advantage of the opportunity to also share COVID-19 prevention information.
“If the pandemic continues, which is very likely, these one-on-one activities will be our norm. At this point, we will continue to implement this new approach, and also make use of various internet-based applications to communicate with each other and to support members of key populations groups.”
Taking COVID-19 information and TB services to the people
The extreme weather and terrain in Vanuatu can make getting health services and life-saving information to people a real challenge.
The COVID-19 pandemic is adding another layer of adversity.
During the pandemic, Kevin Carter, a Tuberculosis (TB) Officer, and his team from the Tuberculosis (TB) and Leprosy Programme in Tafea province have been ensuring that despite the obstacles, the vital health services they provide would continue unimpeded.
“We were advised by the central Ministry of Health that our TB programme activities should not be placed on hold,” said Kevin. “The TB programme was one of two programmes that have continued despite the current crisis.”
In late April to mid May this year, Kevin and his team of five embarked on one of their regular missions to remote island communities to conduct TB screenings.