In Mozambique, a health worker collects and labels a viral load testing sample.
Current treatment options for HIV/AIDS are so effective that despite being incurable, people can live with an undetectable level of viral load. To reach its country-wide targets, Mozambique needs to expand viral load testing coverage, which was just 63% at the start of the USAID Efficiencies for Clinical HIV Outcomes (ECHO) project. Facing this challenge, USAID ECHO developed a strategy to accelerate viral load coverage that follows a cascading design with four distinct interventions.
USAID ECHO's multi-tiered pediatric quality improvement stratrgy is matching activities to facility needs and contexts. For one family, the flexible and holistic approaches they found at an USAID ECHO-supported facility helped save their son's life-and helped them better understand his condition.
The first intervention, and the most intensive, focuses on hiring a task force of health providers to identify patients eligible for testing, coordinate screenings, facilitate sample collection, and coordinate with laboratories to get samples tested. This is implemented at high-volume facilities. The intermediate intervention contains similar activities but works through internal health unit staff, specifically at facilities that provide patients with one-stop entry-point screening and treatment for HIV-related illnesses. The basic intervention has the same contents but is rolled out to all USAID ECHO-supported health units. Finally, the viral load demand creation intervention promotes activities that raise awareness through messages on community radio stations, educational activities, community health lectures, and viral load literacy programs for young people and adolescents.
This four-pronged strategy has yielded strong results. In June 2022, USAID ECHO reached 71% in viral load testing coverage program wide. Tete Province had the best results, reaching 83% in viral load coverage and 93% in suppression.
Cleyton, a 7-year-old patient who was born with HIV, provides one tangible example of ECHO’s impact on pediatric outcomes. As recently as 2021, Cleyton was undetectable and frequently visited the Moatize health center in Tete with his mother, who was diligent about treatment. When his mother passed during childbirth less than a year later, at-home attention to Cleyton’s care and treatment abruptly declined.
Primary Text"When his mother was alive, Cleyton had an ideal weight for his height, was a very healthy boy, showed no sign of concern around doctors, and when he went to consultations, he interacted with other children."
Saide Mustafa, pediatrician, Moatize helath center
Cleyton started responding negatively to his medication, and his family halted treatment. As part of a USAID ECHO-led initiative, his doctors transitioned him to a better treatment regimen. When challenges persisted, they recommended Cleyton for pediatric counseling. Psychologists took the time to understand the child’s at-home experiences, challenges, and relationships, finally identifying medicine administration issues with his family. This honest and empathetic care uncovered the root causes of Cleyton’s health challenges. Due to the USAID ECHO interventions, at his most recent visit, Cleyton’s viral load was undetectable again.
Building viral suppression in Mozambique requires a flexible approach. USAID ECHO’s strategy ensures that facilities with the most need receive targeted technical assistance. It also ensures that patients have a menu of resources available to them, from One-Stop pediatric care to psychosocial support when traditional problem-solving fails. Understanding each patient’s individual needs, providers at USAID ECHO-supported facilities are matching patients with the right care for them and their families. Ensuring that they live long, healthy, and prosperous lives.