15 November 2017

Namibia Surges Towards 90 - 90:90

ACCORDING to the Namibian surges campaign, it is estimated that 19 people are infected with HIV in the country every day.

The campaign is an effort between the Ministry of Health and Social Services and the Centres for Disease Control and Prevention with funding from Pepfar for the 90:90:90 strategy.

The 90:90:90 targets were launched in 2014 by the United Nations Programme on HIV-AIDS (UNAIDS) and partners with the aim to diagnose 90% of all HIV-positive persons, provide antiretroviral therapy (ART) for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020.

The surges campaign says for Namibia to end the epidemic, there is need to ensure that people are able to regularly access testing.

The deputy health minister, Juliet Kavetuna, said the campaign was a booster strategy intended to increase testing uptake among men by reducing the missed opportunities of provider-initiated HIV testing at outpatient departments.

"This is because we know that men are less likely than women to seek healthcare in general and HIV testing in particular. However, we know that men visit hospitals and clinics when they are unwell or are in need of healthcare services.

"But, on many of these visits, HIV testing is not done, often due to testing services not being readily available, limited numbers of trained service providers available to do testing and a tendency by service providers to target HIV testing services only for people deemed to be at high risk rather than as a general service for all," Kavetuna said.

She further said they also know that while people can be reluctant to test for HIV, they are often interested to be screened for other assessments of wellness such as body-mass index, blood pressure, blood sugar levels and cholesterol levels.

"The programme was implemented in six hospitals over a four-month period. The hospitals were selected due to the high number of patients visiting the outpatient clinics correlated with the known high burden of HIV in these areas. At each site, a marquee was erected near the outpatient department to provide the necessary space."

She added that the services proved popular, with a total of 5 200 people receiving the healthcare services, which were available at each site for 10 days.

Kavetuna added that the campaign increased both HIV testing volumes and case identification efforts, particularly among men.

"Usually men represent 25% of people tested; in the campaign men represented 50% of people tested, with a 100% increase in reach.

"Importantly, the majority of people tested were first-time testers, furthermore, nearly all of the newly diagnosed HIV positive men agreed to have their sexual partners checked for the disease and were immediately linked to treatment and care," Kavetuna said.

The men attending were in groups, friends who had come together or colleagues stopping at the service before a shift, Kavetuna added.

She further noted that this was because while the original purpose of the campaign was to access patients at the outpatient departments, news of the service spread and people came to the sites specifically for these services.

"Some people took annual leave just to have the opportunity to receive the screenings, while others working nearby used their lunch-breaks to get tested. The importance of peer support was evident, with the young men wanting to tell their stories laughing and joking with each another as they waited to be tested."

Although it is often said that men do not want to be tested because they do not want to tell their friends if they are HIV positive, the fact that men came in groups refutes that, the deputy minister asserted.

"Instead, we saw men coming together to give each other the confidence to get tested. The importance of peer-to-peer support among men who go for HIV testing was clear. Although the key target audience was men, the service was intended for all, young, old, individuals, and couples," she said.

Kavetuna noted that overall, the surge campaign showed that if services are made available in a format that suits people's needs, people will use them. The campaign also showed how important healthcare is to people.

"As Namibia moves closer to its 90:90:90 targets, the pressure to find the remaining unidentified positives intensifies. But we must not lose sight of the fact that many of those already tested need to continue to test regularly," said Kavetuna.

The health ministry, in collaboration with CDC is working to make it standard that every client who visits the outpatient department will have the opportunity to be tested. The campaign also showed that multi-disease testing is a pull-factor for HIV testing and that many young men want to get tested. Most strikingly, it showed that peer support matters and more needs to be done to encourage this.

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