A group of ladies sit waiting for consultations, or to see the MSF medical doctors at an MSF mobile clinic site in Bodo, a village just outside Yambio, in Gbudwe State, South Sudan. Photograph by Charles Atiki Lomodong Photograph by Charles Atiki Lomodong
Feature story |

South Sudan: Delivering HIV treatment to conflict area

Photograph by Charles Atiki Lomodong
A group of ladies sit waiting for consultations, or to see the MSF medical doctors at an MSF mobile clinic site in Bodo, a village just outside Yambio, in Gbudwe State, South Sudan. Photograph by Charles Atiki Lomodong Photograph by Charles Atiki Lomodong

Yambio´s Test and Treat pilot project improves the lives of people living with HIV

For many people in rural South Sudan, HIV testing and antiretroviral therapy (ART) is nearly impossible to obtain. Moving from village to village is extremely difficult, and the war has forced many to flee to isolated locations. But in Yambio County, in the southwest, things are different as a pilot project is providing care to many people living with HIV. Through mobile, same day testing and treatment, provided by Médecins Sans Frontières (MSF) the lives of people living with HIV and their families are changed for the better.

“In the past, there was very little treatment for people living with HIV in the area. The sick just suffered and died,” says Arkangelo Ruben, a tribal chief and community leader from South Sudan's Western Equatoria region. “Reaching a town with a drug dispensary usually took several days. Things got worse when the fighting started as many fled to areas with no access to healthcare.”

MSF has had a long association with Yambio in Western Equatoria through its partnership with the state-level Ministry of Health and wanted to examine the best way of providing antiretroviral therapy to the population in the countryside around Yambio where HIV prevalence is at 3.4 percent, well over the national average.

“Access to life-saving HIV care should not just be for people living in stable contexts or living close to health structures. In Yambio, we want to show that it is possible to put in place a system where people living with HIV can access services even in challenging environments,” says Jaume Rado, MSF head of mission in South Sudan.

To meet this challenge MSF initiated a “Test and Treat” pilot programme, with the support of the Ministry of Health, which has now been running for two-and-half years in Yambio County, and will finish in June 2018. Two mobile teams are running six centres where people are tested and receive ART in the surrounding countryside.

"Rather than make patients come to a distant clinic or dispensary, our service calls into rural communities at set times,” says Farhan Adan, MSF project coordinator in Yambio. “A patient could be tested and have the results in a day. Treatment can start immediately. We also have counselors who can explain how HIV will impact patient´s lives and community health workers who can even deliver drugs to very isolated places.”

“While this concept is new to this region, the Test and Treat approach has been tried in other parts of Africa and was first introduced by the WHO. The one big difference with this project is that Yambio is in a conflict setting. From time to time the level of violence flares up, leaving populations cut off from the outside world.”

“In the early days, it was much harder. We had to go from house to house knocking on doors. Sometimes the families lived in very isolated parts of the forest; community health workers had to walk for hours to find their huts”, explains, Isaac Zinaro, MSF’s community health worker supervisor. “Now people know when we are in their village and how to access our services.”

The most recent figures are promising. Between June 2015 and the start of November 2017, 14,804 people were tested for HIV. Of those, 505 tested positive and 401 were enrolled in the programme. The majority of those not in the program decided not to participate despite counseling or for personal reasons.

The flexibility of MSF’s Test and Treat community-based model means that patients have unbroken access to the drugs they need. Patients can be given medication to last three months, even if their villages are cut off.

“If teams cannot access an area, a volunteer or focal point is selected to collect the drugs for a group of patients. These patient groups also serve as support groups, reinforcing the community/patient centred model of treatment,” explains Beatriz, the head medic for the Yambio team. “It’s not quite door-to-door delivery, but it is as near to it as possible in this situation.”

One patient benefiting from Test and Treat is Nama Martin, who was diagnosed as HIV-positive 10 years ago. “I look after 15 children. You can see that I don’t have any money and very little time. It used to take me two days to travel to Yambio and back and I had to include the cost of a night’s accommodation. My children were alone. Now my medicine comes to a village which is walking distance.”

As the pilot phase nears its end, a local partner, Catholic Medical Mission Board is gearing up to take over the project.

“With the Yambio areas covered by our project, the next step is to pass on what we have learned from the pilot programme to other health providers with the help of the Ministry of Health,” says Jaume Rado. “Many other communities that have been affected by instability and many displaced people can benefit from what we have developed.”