For PIH and our partner organizations on four continents, 2006 was another year of daunting challenges and striking achievements.
For the second consecutive year, we launched a new project, this time in Lesotho, at the very heart of the AIDS pandemic in southern Africa. Working at a remote mountain clinic, in an area where more than half the adult population may be infected with HIV, we succeeded in testing more than 1,000 people and enrolling almost 200 on treatment within barely six months.
We also strengthened and expanded our operations in countries where we have been working for many years. We constructed and inaugurated new facilities in Peru, Haiti and Rwanda. We substantially increased the numbers of patients we serve and initiated major new programs to serve them better. In Peru, for example, we built on our experience and success in community-based care for tuberculosis to launch a program for patients infected with HIV. And in Russia, for the first time, we trained and hired community health workers to bring care and social support to the most vulnerable patients in their homes.
Some of the highlights of the year at our various sites are described below. For more details on individual countries, click on the sub-titles below or the links in the column to the right.
In 2006, Zanmi Lasante expanded its groundbreaking HIV Equity Initiative beyond the Central Plateau to two new sites in the Artibonite region of Haiti. The Artibonite clinics were rapidly scaled up to offer people living with HIV the same PIH model of comprehensive care—including accompaniment, socioeconomic support, and free medical care—that has proven so successful since Zanmi Lasante launched the HIV Equity Initiative in 2000 and extended it throughout the Central Plateau.
Inauguration of the new Zanmi Lasante facilities at Cerca La Source
In August 2006, Zanmi Lasante and the Haitian Ministry of Health inaugurated a medical center in the Central Plateau town of Thomonde. This new facility provides comprehensive primary care and HIV/AIDS services to an average of 200 patients per day. During 2006, ZL also officially inaugurated a new clinic in Cerca La Source, a new pavilion in Hinche and the Sante Fanm women's health center in Cange.
Delivering DOTS-Plus in the community
Throughout 2006, SES worked with local ministries of health to expand treatment for MDR-TB patients both within and beyond Lima. In Arequipa, a major city in the south, the Regional Health Directorate committed to working with SES to expand and improve MDR-TB care. Patients are already enrolling in the DOTS-Plus program there. In Lima, almost 500 of our patients were declared completely cured; another 500 are still receiving medical treatment as well as nutritional, social, and economic support. SES sponsored weekly group therapy sessions over the course of the year, as well as thoracic surgeries for 77 patients. Finally, the committee responsible for decisions regarding treatment protocols has been expanded to include additional health and social service professionals; they will provide a more balanced and comprehensive view of TB treatment and decision making.
While continuing its longstanding work with MDR-TB, SES has taken on an important role in scaling up treatment for HIV, particularly among patients co-infected with TB and HIV. 79 HIV-positive patients are now receiving comprehensive care through the SES HIV program; at the end of 2006, 94 percent of these patients were clinically stable and had an undetectable viral load. The HIV team works with 17 volunteer health workers who administer life-saving antiretroviral drugs to patients and give them critical emotional, economic, and nutritional support. The team also works in tandem with the Ministry of Health’s National HIV program to improve patient enrollment and adherenced to treatment.
During 2005, PIH had succeeded in transforming the broken-down facility in Rwinkwavu from a collection of crumbling buildings with no electricity, no doctors, few medicines and only a handful of overworked nurses into a functioning district hospital. In 2006, we continued to improve facilities and services at the hospital with the addition of a new pediatric ward and a functioning operating room.
The new pediatric ward at Rwinkwavu Hospital
Rwinkwavu Hospital opened its pediatric ward and inpatient malnutrition center in February 2006, with support from the Clinton Foundation and UNICEF. The 30-bed pediatric care center serves as a referral facility for complicated pediatric cases from all six PIH Rwanda sites.
PIH Rwanda enrolled over 150 children living with AIDS on lifesaving ART and instituted comprehensive prevention of mother-to-child transmission (PMTCT) programs at all six clinical sites in 2006. Children living with AIDS and their families meet for monthly pediatric counseling groups, where PIH Rwanda staff provide education and psychosocial support. Around Rwinkwavu, PIH Rwanda staff and patients conduct HIV education programs at local primary and secondary schools, with plans for expansion in 2007.
Working in collaboration with the Russian Ministry of Health and the World Health Organization, PIH Russia led three comprehensive training sessions on management of multidrug-resistant TB for doctors from the Russian medical system. Two sessions were held near Moscow and one in Novosibirsk, Siberia, providing training to 213 physicians representing 80 percent of the territory of the Russian Federation. With continuing support from the Eli Lilly and Company Foundation, two more sessions are planned in 2007 to extend training to the entire country.
In November, PIH Russia and Tomsk Oblast TB Services launched a new pilot outreach program to improve treatment adherence and support for the poorest and most neglected MDR-TB patients in the region. The "Sputnik Program" marks the first use in Russia of what has long been a key component of PIH's model of care in other countries – recruiting, training and paying community health workers to provide directly observed therapy and comprehensive social, nutritional and medical support.
A village health worker delivers medication to an HIV patient in Lesotho
In July 2006, PIH Lesotho started its first 16 AIDS patients on antiretroviral therapy (ART) at the Nohana Health Center. As news of the remarkable recovery of these patients spread throughout the area, the number of people seeking HIV testing or treatment at the Nohana Health Center increased dramatically. Within just six months, more than 170 patients were receiving ART at the Nohana Health Center and over 450 were enrolled in pre-ART care.
Testing in Nohana has confirmed high rates of tuberculosis and of HIV-TB coinfection. Although the National Tuberculosis Program offers limited support for diagnosis and treatment, PIH has identified almost 100 active cases of TB, among whom more than 90 percent are coinfected with HIV. Outbreaks of multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB and XDR-TB) in neighboring South Africa raised concern about drug-resistant tuberculosis in Lesotho. In response, PIH Lesotho partnered with the National Tuberculosis Program of Lesotho to conduct a rapid survey of two Lesotho districts bordering the affected region of KwaZulu-Natal Province, South Africa, during October and November of 2006. The survey will provide a snapshot of the extent of MDR-TB and XDR-TB in Lesotho.
During 2006, enrollment into PACT health promotion and directly observed therapy for HIV patients increased by 115 percent. PACT staff began an extensive outreach campaign designed to reach patients who have experienced difficulty adhering to treatment and accessing care and could benefit from PACT services.
PACT services expanded from the inner-city neighborhoods of Dorchester and Roxbury to serve the greater Boston area, as PACT developed new partnerships with healthcare providers to reach more of the area’s most vulnerable communities.
In addition, PACT staff traveled to Puerto Rico, New York City, Miami, and Wisconsin to engage in new collaborations with groups interested in replicating the PACT model of health promotion.
In 2006, staff from EAPSEC (Equipo de Apoyo en Salud y Educación Comunitaria, the PIH-supported project in Chiapas, Mexico) trained 137 health promoters to work in 11 municipalities and 83 communities across four regions of Chiapas, serving an area of approximately 16,900 people.
EAPSEC health promoters led a record number of educational community health talks in 2006, on subjects ranging from potable water, hygiene, and construction of sanitary latrines to nutrition and mental health issues.
[posted January 2007]