Cameroon Link engages in Community Dispensation of ARV for PLHIV

Monthly Report of October 2021 The Themonth started with the first weekly evaluation and review meeting. The UPEC Coordinator, Dr. Serge Djombissie welcomed the participants after prayers. Each focal point presented a report on the work realized. In the reports, issues related to the daily appointment register for PLHIV on ART were handled. These included the data of viral load collection (VL), ART Code, initials of first and last name of patients, sex, age, contact telephone numbers address of residential area of patients and general observations. The general observations indicate the actual situation of patient, which include transfer of patients, search of PLHIV who have not shown up for more than three months and follow up initiatives to get their where about or whether they are dead. On the appointment register is put the date of the next appointment and month the patient has to show up at the health facility (FOSA) for a check up.

The officials insisted on punctuality for meetings and dispatching of reports. Focal points are requested to get their reports ready ahead of the meeting day to share knowledge on the global situation for appreciation. There are focal points that arrive at meetings without completed reports. It was suggested that focal points should be coached on making presentations during meetings to familiarize them on the technique of reporting. Since the hospital operates with two languages, English and French, both will be used for expression where necessary. Each focal point in the presentation gives the number of patients expected during the week and month with the number of persons who showed up and number of absentees. A percentage of the result is given as out-come. The number of persons screened and initiated on ART is also presented. Baptist Hospital of Mboppi has 23 Cohorts currently caring for over 5.000 PLHIV. These include different age groups starting from babies, persons above 10 years and persons above 40 years. Men and women married and not married. The hospital is caring for over 5.000 PLHIV has the problem of insufficiency of ART for multi-months dispensation. The quantity received is not enough and the hospital has adoptd monthly dispensation instead of quarterly semester deliveries. At Baptist Hospital Mboppi, members of Cameroon Link were attached to the pharmacy to learn about the circuit for dispensation of ART and the different types of ART available. James Achanyi Fontem continues coaching at the consultation level to get insights on the different approaches and difficulties for receiving and interviewing patients during checkups with the UPEC. It was noted that each patient has a particular attitude and the approach and collection of information is diverse. There are patients that do not respect their appointment dates and the reasons are collected like illness and travel or busy occupations periods. The number of tablets he/she has is asked and this facilittes in taking the decision on the number of tablets to be served the patients. Some patients’ complained of side effects of the ART they received like itching and rashes on the skin. They are asked when the itching started and the type of water they bath with. Most of those who complained of itches use water from the wells. This means the wells need some purification with a few drops of camel water regularly. Due to the nature of daily occupations of some patients, a request is proposed for change of the time to take the ART. Some prefer in the morning and others in the evening. The patients are advised to respect the time for taking their ART. They are informed that the most recent generic of ART is programmed for early in the morning and preferably at 07H00 because it keeps the patient awake throughout the day. IF TAKEN IN THE EVENING, IT RETARDS SLEEP. Other types of tablets make the patient to be dizzy and it is advised to take them in the evening instead of the morning. All pregnant mothers who arrive to start pre-natal consultation are screened automatically. This facilitates decision making on the therapeutic ART FOR THE PROTECTION OF THE MOTHER AND FEATUS. Special files are opened for pregnant mothers and newly delivered babies. It should be recalled that the Baptist Hospital in Mboppi receives over 5.000 patients on ART and data is updated during weekly meetings on Tuesday afternoon coordinated by the UPEC boss, Dr. Serge. During the meetings, focal points present data collected and report on attendance or respect of appointments by patients and difficulties encountered. There are cases of patients who want to be served multiple months ART because they have left Douala for their villages in other regions. Asked whether they needed a transfer to their new residences or locations, they refuse and prefer to be served from CBC Hospital Mboppi. Asked whether they have any persons who could collect their ART and send to them where they are now residing, they hesitate giving any names. The ART given now to patients covers only a period of one month and patients have to go to the health facility every month to be served. Some patients are married but both do not live in the same town or home. This is a problem. For patients on ARV, it is important to understand that the treatment is for life and there should be no break. A break gives the virus opportunity to become resistant. If a patient cannot go to the health facility to collect his/her ARV, a relative or friend should be sent to do so. Patients should avoid having bruises or openings on the skin. It creates opportunities for infections. Often the part of the body infected swells as a sign and this must be treated immediately. The patients should be able to say if he/she is having any side effects during treatment. These are often issues that need to be handled and addressed quickly. Child care is very important for mothers that are breastfeeding. Babies that breastfeed are always very alert and interested in what happens around them. They act sometimes like adults in search of things they can carry along with them. It may be your phone, your keys or anything attractive. Babies suck the breast anywhere and it should be known that it is the right of the baby. The breast of a woman is for producing the baby’s milk. Baptist Hospital in Mboppi promotes exclusive breastfeeding for the first six months after the birth of a baby and follows up the mother with a rapid test to guarantee that it is safe. As concerns the time for taking the ARV either in the morning or in the evening, an alarm clock is necessary because it awakens the patient and reminds him/her of the time to take the ART.

The report of validation for the month of August and September 2021 was presented to highlight the information needed by UPEC and GTR-Sida/ Littoral. This report covered the number of new cases diagnosed and the number of patients served with ARV. The objective of community dispensation is to reduce long waits of patients when they arrive the health facility (FOSA) and to reduce distances from their residences and spending on transport fares to collect their drugs. The UPEC Coordinator emphasized on the need to remind patients on the appointments for collection of their ARV two days to the stipulated date. Patients who fail to show up for appointments for three months are directed to the health facility (FOSA) for retesting or screening after counseling. New Horizon, the project to monitor cases of children infected has been launched. The pilot phase is currently taking place in Yaoundé and Douala. It is after the pilot phase that activities will be spread throughout the republic. The virus and its development in the body is explained by actors involved in prevention. The virus spreads very fast where the patient is faced with other problems related to itching, rashes, fever, tuberculosis, malnutrition, diarrhea just to name a few. When the virus penetrates the body, it hides in blood cells and reduces CD4 known as soldiers. Illnesses related to skin diseases show up as signs. One-third of children infected die because their cells are weak. Children with HIV I die before the age of 5 years, while those infected by HIV II die before the age of 10 years. The number of CD4 varies with age and synthoms. At the third level, the symptoms’ of tuberculosis and diarrhea show up. When a patient arrives the health facility (FOSA) with an opportunistic problem, the viral charge load (CV) test is done before any prescription. It was noted that Index Testing at Baptist Hospital Mboppi has been very low and it is below 5%. The coordinator said this sector of HIV prevention activity has been dormant and needs to be activated. He encouraged actors to improve on their strategy working with sex workers. At least 36 cases should be identified weekly. Line listing activities need to be improved also to improve on data collection. This will be considered as evidence of what is happening in the district. Actors were invited to dialogue in the whatsapp group and share their experiences. Generally, messages are put on the group for reaction, but no responses are received. The purpose of the group is to harmonize the strategies in what everybody should be doing. Doing the same thing and updating knowledge at the same time improves on work. Sensitization messages should be harmonized. Actors should avoid frightening patients, especially on the adoption of certain conduct and attitudes like drinking or eating bitter kola for example. The use of telephones for booking appointments is necessary. Each time one is with a patient, the telephone number given should be verified immediately. Often, some patients give wrong telephone numbers and some even change their numbers and residences without notifying the UPEC or APS in charge. Patients will give all types of excuses for not taking their ARV regularly, Actors should emphasize on the need to respect the time announced during prescription and report if they have any difficulties. They are advised to use alarm clocks and watches as reminder tools. This is important. Another specialized group of counsellors has been introduced at Baptist Hospital Mboppi. These counsellors focus and target single mothers who are parents with children without husbands. It has been observed that this group of mothers hav specific problems and requests to be tackled very strategically. They were given the opportunity to explain what their work consists of and how they are going to work with UPEC actors attached to the Mboppi hospital during weekly evaluation meeting. It was noted that some of these mothers refuse to disclose their situation, though they need support. There are women living with many men but do not disclose their situation to the partners because they fear to be abandoned. It was advised that actors should encourage patients to adhere to their treatment. There should be continuous monitoring by actors. Actors should make efforts to counsel both partners because this creates better security for their health and wellbeing. The role of the counsellor is to educate and convince patients to adhere on the right decision. EGPAF has put an incentive for motivating actors to improve on their performances. Those who will succeed to convince parents and sex workers to join in the HIV prevention strategy wagon and adopt positive strategies will be compensated monthly if they come up with one case or more each week. Way Forward from October 21 To get a clear picture of how prepared Cameroon Link was, a third and final site evaluation took place on the 27th October 2021 and we have below traced activities and evaluation sessions organized at the level of the CBO, Hopital General and UPEC Mboppi. We organized working sessions with Cameroon Link staff on startegies for collaboration with Hopital General and Baptist Hospital Mboppi. The CBO Focal point, the UPEC Coordinator of Baptist Hospital Mboppi and EGPAF Representative at the district were guided by the focal point of CBOs on updates of appropriateness of Cameroon Link . Staff immediately engaged in the adaptation of the instructions received. From the month of July 2021, staff of Cameroon Link started attending evaluation meetings of CBOs and APS to learn about the circuit of ARV and dispensation in the community through reports presented by actors already involved in the system. This concerned reporting on data of PLHIV in each health area, the respect of appointments, sensitization and counselling of PLHIV just to name a few activities. Reports of the meetings and working sessions at Baptist Hospital and New Bell District level were shared with staff for updates. The focal point of CBOs, has coached staff of Cameroon Link on the filling of the DAILY APPOINTMENT REGISTER FOR PLHIV on ARV and the HIV Anti-retroviral dispensation register. Since the 14th July, 2021 the CBOs’ Focal Point for Baptist Hospital (CBC) Mboppi, the UPEC Coordinator and EGPAF Project representative, have trained and informed Cameroon Link staff on the management of Cohorts through the register and sharing of data. They have been informed that some 500 PLHIV will be handled by Cameroon Link CBO in Bonaberi-Douala. For this reason, the training at the UPEC has focused on two main registers used during community dispensation of HIV anti-retroviral therapy drugs notably: 1. DAILY APPOINTMENT REGISTER FOR PLHIV ON ART 2. TRACKING REGISTER FOR RESEARCH OF PLHIV ABSENCES OR LOSS In the dispensation register each of the 17 Cohorts will occupy one page in the register and it was explained that the patients will be drawn from the period 2008 to 2019. Patients will be followed up by Health Facilities (FOSA) for 24 months before they are transferred to CBOs when their Viral Loads (CV) are considered stable. The 500 patients announced will be classified at Cameroon Link under 17 Cohorts as follows: 1. January 2000 – July 2008 2. August 2008 - August 2009 3. September 2009 - August 2010 4. September 2010 – July 2011 5. August 2011 – July 2012 6. July 2012 – MAY 2013 7. June 2013 – March 2014 8. April 2014 – December 2014 9. January 2015 – August 2015 10. September 2015 – March 2016 11. April 2016 – August 2016 12. September 2016 – February 2017 13. March 2017 – July 2017 14. August 2017 – March 2018 15. April 2018 – September 2018 16. October 2018 – December 2018 17. January 2019 – December 2019 After the first evaluation of the Cameroon Link site, a second evaluation was expected in the month of September 2021 before effective transfer of PLHIV to the community site for dispensation of ARV. Cameroon Link has prepared tracks to facilitate access to Cameroon Link in Bonaberi and these tracks are shared with patients put on the transfer list. The staff designated and trained to participate in the dispensation process at Cameroon link is as follows: 1.James Achanyi Fontem, Team Leader, Tel.: +237 677758840 2.Ojong Helen Ayamba, Nurse, +237 651776537 3. Kamdom Dzukam Christaine Laure, Asistant Nurse. +237 699877186 4. Mbon Flavie Marcelle , +237 675445953 5.Tsopgue Kemti Sandry Doriane, +237 675171014 Evaluation of monthly activities The report shows the following: No of patients expected: 20 No of patients received: 20 No of patients absent with the number of months inclusive: 0 No of patients that have abandoned their treatment: 0 No of home visits organized: 3 No of patients recovered: 0 No of support groups: 2 No of Men: 6 No of women: 14 It should be noted that most of the PLHIV in the residential area of Bonaberi are Internally Displaced Persons (IDP). It is the role of the CBO to organize home visits to encourage patients who abandoned their treatment to continue taking their drugs and the home visits are reported every three months The cohorts covered by Cameroon link are from 2000 to 2018 Cameroon Link started identifying the residences’ and localization zones of patients to facilitate planning of home visits. The telephone numbers of patients are recorded with the name of a family relative who can pick up the drugs of the patients if he/she cannot come to Cameroon Link office. This information is noted on the CBO tracking sheet. The beginning of the 2021/2022 activities started on the 1st October 2021.