Membership Spotlight: Jhpiego

A SPOTLIGHT ON Jhpiego

Catalyzing HIV self-testing initiatives in Malawi

For this month’s spotlight, the Self-Care Trailblazer Group is focusing on Jhpiego, an international non-profit health organization affiliated with Johns Hopkins University. Learn more from Jhpiego’s Megan Christofield, Getrude Chipungu, and Ernest Nkhoma. 
 
TELL US A BIT ABOUT YOUR ORGANIZATION!

Since its founding in 1974, Jhpiego has been innovating to save the lives of women and families worldwide. 

Jhpiego creates and delivers transformative health care solutions that save lives. In partnership with national governments, health experts and local communities, Jhpiego builds health providers’ skills and develops systems that save lives now and guarantee healthier futures for women and their families.

WHY DOES JHPIEGO CONSIDER SELF-CARE TO BE A VITAL PART OF HEALTH CARE SYSTEMS? 

Self-care is a critical complement to provider- and system-led care, and when implemented thoughtfully self-care can leverage efficiencies and reallocate power to achieve greater health at scale.

While much of self-care may occur outside of a health facility, it optimizes the very health outcomes we strive for day in and day out at Jhpiego. It is both the foundation and the multiplier of health.

And, increasingly, it’s important to find the balance between self-care and what we rely on healthcare workers and health systems to deliver so that health systems are stronger and more resilient, both during the COVID-19 pandemic and for the future.

HOW DOES Jhpiego BELIEVE SELF-CARE CAN BE ENABLED DURING THE PANDEMIC?

Throughout the world, men, young people and partners of people living with HIV (PLHIV) have a need for increased access to HIV testing, treatment and services. And now with the COVID-19 pandemic limiting in-person access to testing and treatment options, this need has never been more apparent.

As the global pandemic hits populations already facing an HIV epidemic, we have seen how valuable self-testing can be, putting the power and control in individual’s hands while keeping them safe and physically distant.

As one way to increase access to HIV self-tests, especially to those who need it most, the Jhpiego Gateway Project launched its HIV self-testing (HIVST) initiative in four districts of Malawi. The program was launched first in the Blantyre district in January 2019 before rolling out to the other three districts in October 2019. This program is uniquely situated to bridge the gap of HIV testing with men who are often too busy in their place of work to get tested as well as adolescent girls and young women who often face barriers in accessing testing services.

This project was developed to enhance linkage to treatment for those who test HIV positive and linkage to HIV prevention services for those who test negative. The goal? To catalyze and potentially increase the frequency of HIV testing in population at high risk of infection, with the aim of normalizing testing in this population.

Our method?

With both primary and secondary distribution methods, our project aimed to reach HIV self-test recipients at different locations or distribution points.  

Alongside the Ministry of Health, Jhpiego has identified and targeted key and priority populations most at risk of contracting HIV. Among this population, Jhpiego and the Ministry of Health have introduced multiple HIV testing campaigns to enroll a higher proportion of people into care and treatment.

Through formal distribution centers, Jhpiego targeted young men at the workplace. But we didn’t stop there. Other community points of distribution such as marketplaces, informal settlements, and school systems were also targeted in order to reach adolescents and youth between the ages of 15-24. In order to ensure that no population was left behind, our project also collaborated with community leaders for community leaders to raise awareness and distribute HIVST basic information, even going door to door to distribute test kits in hard to reach areas.

So, what have we learned so far?

With the implementation of the Gateway Project, we have found that location matters. In rural, or hard to reach areas, HIVST kits were distributed more commonly through door to door distribution methods. However, in more urban areas, HIVST distribution was more popular in the formal and informal workplace.

In order to better serve the population, we also now know that the type of testing method matters. Through this project, we saw an increased demand for HIVST kits among more than just the “target” consumer with clients preferring HIVST kits over conventional testing methods.

This project taught us that while HIVST kits are designed with the user’s experience in mind, there is still room for error — particularly when it comes to distribution of kits to clients to be used by their sexual partners or children. In certain situations, tests may give invalid results due to incorrect test performance. Additionally, in cases where clients tested themselves positive, it can be harder to actively follow up and trace the link to HIV services and treatment.

These challenges offer us a chance to reflect and pivot as we continue to push forward distribution to reach individuals across the country.

As the COVID-19 pandemic continues, we have the opportunity to take these lessons learned and transform the status quo in health care, in order to reduce the strain on healthcare systems and build better for tomorrow.

To learn more about this program, dive into the ways that the Gateway Project encourages people to meet their own health needs through HIV self-testing and self-care, here.