Cameroon Link participates in New Bell District COORDINATION MEETING OF OCTOBER 2021

Eliszabeth Glaser Pediatric AIDS Foundation, EGPAF, sponsored the New Bell District Coordination Meeting of 12th October 2021 at Design Hotel in Bali-Douala presided over by the representative of the regional delegate for public health in the Littoral. Mrs. BAYICKE Chimene made a presentation of the objective of the meeting and designated minute s secretaries. She told participants that it was an opportunity to make an evaluation of progress in the prevention of the spread of HIV in the past three months, exchange on the challenges and make proposals on the best strategies to fill the gaps created by obstacles. She focused her attention on the coordination of activities in the health district during the month of September 2021. The officer in charge of monitoring and evaluation presented data collected for the 4th cluster and the results expected. The data was discussed and validated after a question and answer session. There was followed by the moderation of presentations of the different project sites, trigulation of data from the sites and validation. Dr. Sih made a presentation on the situation of HIV therapeutic drugs , the stock and challenges during delivery in each site site. It was noted that some sites like Baptist Hospital Mboppi with over 5.000 PLHIV do not receive enough stock to satisfy patients and most patients receive their ART monthly and not quarterly or bi-annually as recommended by the protocols.

The leader of the TB Unit made a presentation of activities in her sector and it was noted that some patients receive treatment but it is not documented. The coordinators of the different sites were advised to update their data for presentation of the real situation in each site. Some patients change their residential areas and telephone numbers and are lost during tracking especially when they move from one region to another. It was advised that tracking should be done and coordinators of TB in the new sites of the patients informed for better follow up. Mrs. Abomo presented the best strategies for tracking TB patients to guarantee that treatment protocols are respected to avoid transmission to other persons. At New Bell Prison, patients are sent home after completing their prison terms without notification of the health official there. This was given as the reason for incomplete data. If the health centre in New Bell Prison was notified, follow up would have been easier as the staff in the new location of the patients would have been notified to continue follow up. Coordinators of Community based organizations, CBOs, were given the opportunity to make presentations on the activities in their different sites with challenges and suggestions for amelioration of performance. Mr. Mekal of the GTR/AIDS in the littoral presented a review of activities of CBOs during the month of September 2021 in New Bell District. Challenges in relation with the different communities were presented and solutions proposed to improve for better results. The meeting ended with an elaboration of a plan of action for follow up of recommendations. Facilitators were Dr. Mossi, Dr. Sih, Dr. Etoa Mebara, Dr. Bayicke Chimene, Mr. Mekal, Dr. Nyemb Grace of EGPAF and Arnold Ndille of EGPAF, Mme Audrey Sah of GTR. Participants were coordinators of CBOs and UPEC Majors from the lead sites in New Bell, Mboppi, Ad Lucem, CMA Congo, Nkololoun and New Bell Prison. The CBOs were APSUPES, KAMITIK, New Way, FESPAC, and Cameroon Link. There were also representatives of the community, COSADI, COSA, representative of pharmacies and the associate of monitoring and evaluation from New Bell. Cameroon Link was given the opportunity to present the way forward since the signing of protocol agreement with GTR/AIDS for Littoral. To get a clear picture of how prepared Cameroon Link is, we have below traced activities and evaluation sessions organized at the level of the CBO and UPEC since the 10-page protocol document between GTR/Littoral and Cameroon Link was endorsed on the 4th June 2021 and deposited at Hopital General Douala and Baptist Hospital (CBC) Mboppi. 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 registers and sharing of data. Cameroon Link Participates in training on differential models for dispensation The Chief of District of Cite de Palmiers –Douala presided over a training on the diferent models of dispensation of ARV at Bano Palace Hotel on Monday, 25th October 2021 and this brought together team leaders from the health facilities, health technicians, Carers of PLHIV, nurses and persons from community based organisations involved in community dispensation of ARV to PLHIV. The Focal Point of the activity in Cite des Palmiers, Dr. Fon, animated the training session. In the opening address of the Chief of Cite des Palmiers, he said it was an opportunity to share information on the strategies for an efficient delivery of ARV to PLHIV, collecting information o th challeneges and sharing possible solutions for amelioration of services and closing gaps for better results.

Dr. Fon introduced two exposes on the different models for dispensing ARV and a review of the document on registering deaths caused by HIV and transferred PLHIV from one site to another and documentation of anonymous ICT cases. Comments and remarks were made on contributions made by activities related to Family Planning, Prevention of Mother to Child Transmission, district services and PEPFAR before a review of recommendations and key points. This report takes a look at the 10 different models for dispensing ARV and those involved in the execution of each model and how to go about it. The different models for dispensing ARV is an approach which aims at simplifying and adpting services relatd to HIV taking into account the different services awaited by the different groups o PLHIV. This approach also aims at reducing unnecessary cost attributed to the health system. This centers resources of the health facility on persons who need them most. This directive explains the the procedure for documenting the differential models of services (DSD) of dispensation of ARV to patients. It equally defines the different models and codes corresponding to each of them. This directive is for explotation by all staff of CTA and UPEC. It is used in all health facilities (FOSA), UPEC, CTA in the regions of the south and the Littoral. The primary tool of different models for dispensing ARV is the dispensation register of ARV , considering the fact that there are no variable permitting it possible to record the different models in the register. The column for commnts will be used for this purpose. In addition, the dispensation form of the the support groups, ARV registers of CBOs can also serve as source of documentation of thedifferent models of dispensation. Differential models of ARV dispensation (DSD) Individual models based in health facilities (FOSA) DSD1 – Accelerated service (Fast Tracking Services) Definition: Anold patient on ARV without any complaints is received directly at the pharmacy without passing through the medical consultation or para-medical Dispensators: Pharmacists, pharmacy assistant or ACCR Comment to be documented: At the time of dispensation, the consultant registers the the DSD1 Code in the column dedicated for recording the differential model of the patient served. DSD2 - Dis pensation on escort (Rapid Pick Up) Definition:The patient is escorted by a staff of the health facility (FOSA). Dispensator: Pharmacists, pharmacy assistant or ACCR Procedure of dispensation: See definition Comment to be documented: At the time of dispensation, the consultant registers the the DSD2 Code in the for recording the differential model of the patient column dedicated served. DSD3 – Service Convivial (Friendly Services) Definiion: PLHIV receive ARV in a space specially arranged and this a a child friendly corner, adolescent friendly corner, male partner, VIP. And others. Dispensator: Medical Officer/Coordo,Major, ACCR Procedure of dispensation: The dossir of the PLHIV is used as the liaison for dispensation and update in the register for dispensation. The dispensator collects the drugs of the patient and proceed to dispensation proper. Comment to be documented: At the time of dispensation, the consultant registers the the DSD3 Code in the column dedicated for recording the differential model of the patient served. DSD4 – Horaire Flexible (Flexible hours and Odd hours) Definition: The PLHIV is dispensed in the health facility (FOSA) out of normal classical working hours of service and during week ends and public holidays. of dispensation Dispensator: APS, Medical Officer/Coordo, Nirses, ACCR Procedure: ARV are dispensed to the PLHIV out of official working hours and the medical consultation document of the patient is used for updating the register of dispensation. Comment to be documented: At the time of dispensation, the consultant registers the the DSD4 Code in the column dedicated for recording the differential model of the patient served. Model of the group based at the health facility (FOSA) DSD5 – Support group within the health facility (Facility Support Group) Definition: These are PLHIV dispensed within the health facility support group. Dispensator: APS, Medical Officer/Coordo, Nirses, Pair Educators Procedure: ARV are dispensed to the PLHIV during meetings of the support group and the dossier of the patient used for updating the register of dispensation Comment to be documented: At the time of dispensation, the consultant registers the the DSD5 Code in the column dedicated for recording the differential model of the patient served. DSD6 – Dispensation Familiale (Family Dispensation) Definition: The ARV of the patient is collected from the health facility (FOSA) by a a parent of PLHIV. Dispensator: Pharmacists, pharmacy assistant or ACRR Procedure of dispensation: See definition Comment to be documented: At the time of dispensation, the consultant registers the the DSD6 Code in the for recording the differential model of the patient column dedicated served DSD7 – Pair Support Group ( Community led ART Delivery) Definition: The ARV of the patient is are dispensed by a member of a community group of the patient of which he is a member. Amd is served from a health facility (FOSA).collected from the health facility (FOSA) by a a parent of PLHIV. Dispensator: Le pair ( Peer) Procedure of dispensation: The Peer collects the ARV from the health facility (FOSA) and fills the update before collecting the drugs by the patient. Comment to be documented: At the time of dispensation, the consultant registers the the DSD7 Code in the for recording the differential model of the patient column dedicated served. The form signed by the patient is returned to the health facility for documentation. DSD8 – Dispensation a domicile (Home Delivery) Definition: The patient is dispensed at home by a staff of a health facility ( Nurse or APS) Dispensator: APS, ACRR, Medical Officer and Nurse Procedure of dispensation: A form for dispensation/distribution is filled by the dispensator during collection of the drugs at the pharmay. The PLHIV signs on the form to confirm reception of the product and the form is used for update of the dossier of the patient served and in the register of dispensation. Comment to be documented: At the time of dispensation, the staff registers the DSD8 Code in the dispensation register of differential model of the patient column dedicated as served. The form signed by the patient is returned to the health facility for documentation Model of the group based in the community DSD9 – Support Group (CBO Support Group) Definition: The patient is dispensed within the frame work of support group in the community . Dispensator: Responsibility of CBO Procedure of dispensation: A form for dispensation/distribution is filled by the responsible staff of the pharmacy during collection of the drugs at the community pharmacy. The PLHIV signs on the form to confirm reception of the product and the form is used for update of the dossier of the patient served in the register of dispensation. Comment to be documented: At the time of dispensation, the staff of the health facility (FOSA) registers the DSD9 Code in the dispensation register of differential model of the patient column dedicated as served. The form signed by the patient is returned to the health facility for documentation. DSD10 – Dispensation Familiale en Communaute (Family Clinic Community) Definition: Thedrugs of the the patient dispensed is collected at the office of the CBO/OBC, by a PLHIV or a family member of the PLHIV. Dispensator: OBC Procedure of dispensation: A form for dispensation/distribution is filled by the responsible staff of the pharmacy during collection of the drugs at the community pharmacy. The PLHIV signs on the form to confirm reception of the product and the form is used for update of the dossier of the patient served in the register of dispensation. Comment to be documented: At the time of dispensation, the staff of the health facility (FOSA) registers the DSD10 Code in the dispensation register of differential model of the patient column dedicated as served. The form signed by the patient is returned to the health facility for documentation. List of PLHIV for Community Dispensation of ARV – HOPITAL GENERAL/Cameroon Link No Serial Code Name Start Date Contact Residence Tel. No Age 20 – 24 years Age 20 -49 years Age 50 years M F M F M F 1 LT01/01/21/001 Ekongolo Jean M. 08.10.08 G. Souza 653567844 x 2 LT01/01/21/002 Tchamamba Chris 01.09.08 Meleke 697709846 x 3 LT01/01/21/003 Bo0kop Dorine 04.08.09 Miang 67545110 x 4 LT01/01/21/004 Kouague Dorice 01.11.09 Mundani 691929237 x 5 LT01/01/21/005 Kenemben Nathali 15.06.10 Miang 695397746 x 6 LT01/01/21/006 Essoh Fridolin 12.07.10 Souza 674162430 x 7 LT01/01/21/007 Ndongue Bebey 10.06.10 Mangamba 695147378 x 8 LT01/01/21/008 Guekam Auriele 11.02.09 Miang 699213812 x 9 LT01/01/21/009 Kedi Rose 06.09.11 Miang 697966972 x 10 LT01/01/21/010 She Julienne 06.07.11 Bessounkang 694532230 x 11 LT01/01/21/011 Wangue Emile 02.08.10 Bwapaki 679475950 x 12 LT12/16/2160 Heen Fonyuy Anna 20.8.09 Rail Sodiko 677101300 x 13 LT01/01/21/013 Eke Ndong E. 12.04.10 Mangamba 694791550 x 14 LT01/01/21/014 Ngasse Christine 08.05.13 Mangamba 694779215 x 15 LT01/01/21/015 Mbah Christabell 10.09.11 Souza 676188126 x 16 LT01/01/21/016 Menekeng Isabele 11.01.12 Mandouka 670215551 x 17 LT01/01/21/017 Mouako Ewane 19.12.11 Souza 696444053 x 18 LT01/01/21/018 Njikiale Victor 08.05.12 Mbonjo 693596004 x 19 LT01/01/21/019 Abomo Yvette 12.07.13 Qtier Hausa 696152040 x 20 LT01/01/21/020 Elisabeth Njoh 20.03.10 G.Souza 691425868 x 2 14/ 2 2 Observations All decisions should be analyzed and adapted to the problem of each PLHIV before execution. This means that patients should be at the center of the pre-occupation of CBOs. It should be noted that Hopital General is a CTA and Baptist Hospital Mboppi is an UPEC. This defines and determines the level and intensity of health practice delivery. A register has to be bought for recprding activities of support groups and home visits. The staff of the CTA and UPEC are requested to support the CBOs during the execution of their activities in the community. DSD accelerated services are carried out by the APS ( Companions of HIV Patients). They are 10 DSD groups concerned with dispensation of ARV as explained above specific spaced in the CTA, UPEC and community. PLHIV should be encouraged to give the names of their partners during the execution of anomymous ICT activities. This can be done by asking them to put the names in a box where ARV are dispensed, because most patients would not like to speak about their partner or partners. Advise them to put the telephone numbers which could be used in contacting them. This technique has been tested and results were positive. PLHIV should be questioned every month on their situation as the ARV are taken and especially if there are any side effects or opportunistic cases. This helps to reduce any resistance of HIV.