The Harvard School of Public Health, in collaboration with the Mozambique Ministry of Health, the Real Medicine Foundation, and the African Millennium Foundation, proposes an 18-month pilot program to provide a comprehensive HIV/AIDS prevention and treatment program in rural Mozambique, for the health district of Xai Xai. A country already plagued by the aftershocks of civil war, floods, and droughts, its weak healthcare infrastructure, and in particular its shortage of healthcare workers, Mozambique is currently unable to reach its geographically distant rural population.
The city of Xai Xai, located in the Gaza Province has one of the highest rates of HIV in the country because of its location along one of the major migrant labor routes, as well as the continued marginalization of many of its rural inhabitants from the healthcare system. This program will focus on targeting the wives of migrant laborers through trained female community health workers, simultaneously expanding prevention and treatment services to a marginalized population, as well as contribute to the empowerment of rural women.
While a resolution to this issue is ideal, in the meantime people living with HIV/AIDS in Mozambique need immediate access to ARV treatment. Thus, a more urgent solution is needed. Medical doctors within the country are limited and because those living in rural regions have virtually no access to them, the next step is to train community healthcare workers to administer ARV treatment to these marginalized patients under strict observation, which would not only increase access to treatment but also help prevent potential drug resistance.
A template for this model of community healthcare workers is the Directly Observed Therapy method for tuberculosis, in particular the successful use of accompagnateurs, or community health workers, in rural Haiti. The accompagnateurs are the structural backbone of the program. They are often well-respected members of the community and serve as the essential link between the villages and the clinic. Accompagnateurs are specially trained on the importance of confidentiality and emotional support for the patients, as well as the clinical presentation and management of HIV infection, including proper use of medications and their side effects.
The innovative effectiveness of the system is manifested in the “virtuous social cycle” of many accompagnateurs themselves receiving ARVs from their own accompagnateurs, which often also provides tremendous emotional support. In addition to treatment, the program will provide extensive education outreach programs in addition to voluntary counseling and testing, in order to encourage prevention methods. For the first time, mobile VCT services will be brought to this population, and by adopting the accompagnateur network, which has already proved effective in other countries, a grassroots approach can be adapted to the specific situation in rural Mozambique, and ultimately lead to sustainable development and change.