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Cordaid NL
Health care

ARV treatment: Reaching the unreachables

By air, by road and even canoe we are trying to reach tens of thousands of people in DR Congo whose lives depend on antiretroviral (ARV) treatment. In this epic work to counter the HIV/Aids epidemic, we are generously supported by the Global Fund.

Global Fund Partnership

Cordaid is proud to be part of the Global Fund Partnership in the fight against HIV, tuberculosis and malaria. During the Fifth Replenishment Conference on September 16-17 in Montreal, the Partnership will try to ensure the funds to end the epidemics for good. For Cordaid, it’s an opportunity to double down on our commitment to fight HIV/Aids in DR Congo, even in the most isolated and dangerous places.

In DR Congo, only 27.5% of the estimated 370,000 persons living with HIV have access to antiretroviral therapy. To counter the epidemic, Cordaid leads an alliance of 13 partners fighting  HIV/Aids, with generous support from the Global Fund and in close collaboration with the DRC Ministry of Health.

Getting ARV drugs where they are needed most

By boat, road and air we travel a conflict-affected and weather-beaten stretch of land as big as Germany, France and Italy combined. Together we are doing our utmost to cover that last mile to reach the unreachables and make sure people are tested, counseled  and treated.

If the situation is really too dangerous, the UN has assured us that our drug convoys can be accompanied by Peacekeepers.

Dr Pascal Milenge, Program coordinator

By the end of next year, we want over 150,000 people with HIV on ARV treatment in our program – even in those places that take days to reach or where armed rebels call the shots.

Strengthening the existing health system

We don’t set up parallel medical supply chains, but strengthen the 175 existing health and distribution centers in six provinces with Results-Based Financing. This allows doctors, nurses, pharmacists, peer educators and logisticians to take responsibility, improve their services and have them checked and monitored by patients and their communities. Together they combine forces to fight the epidemic.

Goals and ambitions

Our goals for 2015-2017 are ambitious. We want:

  • to reduce mother-to-child transmission from 34.4% to 8% by the end of 2017;
  • to reduce HIV mortality from 75/1000 in 2012 tot 32/1000 in 2017;
  • to provide ARV treatment to at least 95% of patients with the co-morbidity of HIV and TB by the end of 2017.

Results so far

Less than halfway into the June 2015 – December 2017 program period, the results are significant:

  • the HIV prevalence rate among men and women aged 15-24 dropped from 2.8 to 0.6 between 2011 and 2015;
  • mother-to-child transmission dropped from 38.6 to 22% between 2012 and 2015;
  • and 69,168 of the eligible adults and children are currently receiving antiretroviral treatment in our program.

We support patients during the screening, when they first hear the test results and throughout the years we help them to protect themselves as well as others.

Floride Nsirime, nurse at the diocesan health center of Muhungu

The long road of psychosocial support

One of those persons who is now on ARV is Clémentine, a young mother in South Kivu who is being treated by the medical team of the diocesan health center in Muhungu. She talks about the long and difficult process every HIV-infected person goes through: “I am 32 years old and have a 9-year-old son. I discovered I was HIV-positive during my first pregnancy consultation in 2006. My husband must have infected me, as he was the only one I had had intercourse with. He had never told me he had the disease. In the beginning, I just cried and it took me two years to recover from the shock. Yes, psychosocial support is a long road to travel.”

psycho social support for women living with HIV at the Muhungu health center

Nurse Floride Nsirime with some of the women who are on ARV treatment, Muhungu health center, Bukavu (South Kivu)

Floride, a nurse of the same health center where Clémentine is a patient, further explains: “Three of our staff are fully committed to the Global Fund project. In addition to the medical ARV treatment, psychosocial support is crucial. Many of the patients are mothers, widows and children. We support them during the screening, when they first hear about their being HIV-positive, and throughout the years we help them in protecting themselves as well as others.”

“We know people’s lives depend on our stamina, so we never give up.”

Dr Pascal Milenge, program coordinator

Dealing with danger and insecurity

Getting the ARV drugs for tens of thousands of patients to all 175 health centers – and making sure they don’t run out of stock – is quite a challenge. Dr. Pascal Milenge, our program coordinator who is also responsible for North and South Kivu – two provinces that are particularly affected by armed conflict: “The health centers out there in the remotest parts cannot afford to run out of stock. Our job is to make sure that every three months their stocks are repleted and they even have one month’s reserve. We also operate in areas where armed rebel groups create a lot of insecurity and always have to be on our guard. Of course we travel unarmed. But in case the situation is really too dangerous, the UN has assured us that our drug convoys can be accompanied by Peacekeepers.”

He had never told me he had the disease. In the beginning I just cried and it took me two years to recover from the shock.

Clémentine, mother who is on ARV treatment at the Muhungu health center

One way of dealing with insecurity –  which we have done this year – is to furnish the health centers with a six months’ stock instead of three. Transportation is often the most risky part of our health work and this strategy reduces risks of being attacked on the road.

‘We never give up’

Then there’s the notoriously bad condition of the mud roads, with parts often washed away by heavy torrents. Dr Milenge: “In the rainy season, it’s a logistical nightmare to reach some of the villages. But we know people’s lives depend on our stamina, so we never give up.”

In the last years Cordaid has built up a track record as Principal Recipient of the Global Fund in DR Congo. It is this expertise in strengthening health systems in settings of fragility and conflict that we are going to share during the Global Fund Replenishment Conference in Montreal. Hoping this will inspire commitment and investment to save the lives of millions.

In the rainy season, it’s a logistical nightmare to reach some of the villages.

Dr Pascal Milenge

Recommendations

Here are some of the recommendations we will make during this high level meeting:

  • to build resilient health systems, you need to prioritize a results-based financing approach, improve data management and empower communities;
  • and you have to recognize the critical role of civil society organizations and communities in holding Global Fund recipients accountable in the provision and accessibility of good quality health services.

More

> Read more about our Global Fund program in DR Congo.

> And here’s more information about the Global Fund Fifth Replenishment Conference in Montreal.