Mozambique: Mozambique Mobile Clinic Project
New Efficient Strategies: Q1 2016
July 07, 2016
Summary of Activities
During the first quarter of 2016, the Mobile Clinic continued to implement the strategy presented in January 2012. The main activities of the Mobile Clinic included provision of:
- Primary health care to the populations of Furquia and Mbawa;
- HIV diagnostic, care, and treatment services including integrated TB/HIV services for co-infected patients;
- Antenatal health services and universal ART to pregnant and lactating women;
- Healthcare services and early diagnosis of HIV in infants born to HIV positive women;
- Diagnostic services for TB and TB/HIV co-infected patients’ treatment and care;
- Transport of extra stock of medicine and medical supplies in preparation for potential flooding (and subsequent HF isolation) during the rainy season.
Since the end of the last quarter, with the aim to improve the retention and adherence of patients on ART in the program, the team has been promoting a Rapid Flow strategy: for those patients in good clinical condition, with good adherence and with more than 6 months’ history of taking ARVs, they receive an ARV prescription for three months. During this period, the patient comes every month just to receive the ARV at the pharmacy service; during the third month the patient has a clinical consultation and, if everything is going well, they receive a new 3-month ARV prescription. FGH community health staff continued to provide information, education, and communication on HIV prevention and testing, GBV, treatment adherence, diarrhea, malaria, etc. among the community and patients waiting for consultations at Furquia and Mbawa Health Facilities.
220 new HIV patients were enrolled in clinical care during this quarter.
- Of 863 HIV-positive people receiving care during the reporting period eligible for CTZ prophylaxis, 92% received CTZ prophylaxis. During the reporting period CTZ supply was regular and there were no stock shortages of CTZ, allowing for the improvement of CTZ prophylaxis among eligible patients.
- 201 individuals with advanced HIV infection were newly enrolled on ART: 187 adults and 14 children.
- 197 newly enrolled patients were screened for STIs at the last visit during the reporting period.
- 1,113 HIV-positive patients were screened/assessed for malnutrition; of these, 301 were clinically malnourished.
Serving Individuals as a whole
meeting emotional needs
To improve adherence, Health Facilities supported by the Mobile Clinic continued counting on Mothers to
Mothers support groups. Currently, women meet once per month to share their experiences and receive
orientation from MCH nurses and trained TBAs. After the meeting, HIV positive women join the larger group to
3 FILA: Ficha Individual de Levantamento de ARV participate in the demonstration of nutritional food preparation for children. During this quarter, the subjects discussed included:
- HIV Counseling & Testing
- Living Positively with HIV
- Transmission of HIV from pregnant women to their babies
- Postnatal transmission of HIV (breastfeeding)
- HIV Prevention
- Malaria and diarrhea prevention in preparation for the raining season
Testing and Prevention
During the reporting period, 798 pregnant women were registered for ANC services in the two health units. 718 pregnant women received HIV counseling and testing; of these, 50 had positive results. Partner testing continues to be reinforced through “palestras” (lectures) and with the “Male Champion Strategy” in the HFs and communities to motivate men to accompany their pregnant partners. During this reporting period, 407 partners of pregnant women were tested. 25 were diagnosed HIV positive and referred for ART care and treatment.
serving HIV+ women
Since November 15, 2015, the Zambézia Provincial Laboratory discontinued the processing of PCR samples due to out-of-stock DNA PCR reagents and a change in the manufacturer of the PCR platform. This has created long delays and a large number of back-logged samples waiting to be processed for viral load and Early Infant Diagnosis testing. Consequently:
- During this quarter, only 18 children were enrolled in the Child At-Risk Clinic (CCR) in Furquia and 19 in Mbawa.
- In this reporting period, 22 pediatric patients benefited from virological testing, with 4 positive results (18%)
reported. Rapid testing was offered to 30 children; of these, 1 tested positive (3%).
to priority groups
In order to improve adherence to the HIV care and treatment program, patients with low HIV care adherence, HIV exposed children without PCR tests, patients initiating ART, and post-partum HIV positive women were referred for visits. A total of 105 patients were referred for visits, and an attempt was made to visit all of them (57 in Furquia and 48 in Mbawa). Of the total attempts, 93 (45 in Furquia and 48 in Mbawa) were found (89% of total referred for visits). As in previous reporting periods, other groups like Traditional Birth Attendants, Traditional Healers, and Home-Based Care volunteers continue to provide information and health promotion in their communities and to refer pregnant women and other patients to the health units.
RMF’s Mobile Clinic in Mozambique is a new model of healthcare provision for our organization, conceptualized to reach remote and rural communities with no prior access to health care. Since its inception in 2008, our Mobile Clinic has been hugely successful and remains the only mobile clinic in all of Mozambique. The clinic, a collaboration between RMF, Vanderbilt University’s Friends in Global Health, and Medical Mission International, is currently deployed in one of the most populous provinces of Mozambique, Zambézia Province, located in the central coastal region with a population of almost 4 million.
- To improve the quality of life and provide access to health services, particularly access to maternal-child healthcare and anti-retroviral therapy (ART) for people living with HIV and AIDS, Tuberculosis and other diseases.
- To provide access to healthcare in remote areas of Zambézia Province, Mozambique.
- To reinforce the expansion of HIV care and treatment services initiated by the Zambézia Provincial Health Directorate (DPS), by providing temporary reinforcement in terms of staff, training, and space for peripheral health units initiating implementation of ART until such time as the DPS can organize the infrastructure and resources necessary for these sites to function independently.
Click to enlarge
12,137 people had a clinical consultation at the health facilities in Furquia and Mbawa without the presence of the Mobile Clinic. These are indirect beneficiaries, since they benefited from the increased capacity of health facility staff, due to mentoring activities by Mobile Clinic staff.
Continuous coordination is maintained with the 3 existing Health Councils (Conselhos de Saúde) with 1 monthly meeting held among Health Councils and health facility staff, each averaging 26 participants (Traditional birth attendants, DOT volunteers, Health Council volunteers, polyvalent heath agents, FGH District Community Health Officer, and other volunteers from Ogumaniha and other partners). Consented case finding is supported by Polyvalent Health Agents (APS), Male Champions, Activists from Ogumaniha (this program has just ended, but volunteers are still helping for consented visit and case findings), and Peer Educators.
Overall, there are 6 support groups helping in Furquia:
- Home Based Care: home visits
- Mothers to Mothers groups: nutritional education, demonstrations of enriched food preparation, etc.
- Traditional Birth Attendants: Referrals of pregnant women to the Health Unit, information in the community
about HIV testing, breastfeeding, nutrition, family planning, PMTCT, etc.
- Traditional Healers: Referral of suspected TB patients to the Health Unit, counseling, and sensitization of
chronic patients for HIV testing
- DOTs Volunteers: sputum sample collection of suspected patients, follow up of TB patients in the community,
and references to Health Unit for HIV counseling and testing
- APES (Polyvalent Elementary Health Agent): Health promotion, primary health care, and some consented case
During the reporting period, weekly meetings (4 per month) were held with every support group (with an average of 7 participants per group). MC Counselors joined with health facility staff to participate in these meetings together. Support groups and Peer Educators continued implementing sensitization activities at the community and at health unit level. Mothers to Mothers groups continued to do demonstration of enriched food preparation.