Since the introduction of HIV/AIDS to the present day, significant progress has been made in HIV prevention efforts, and in the care and treatment of those living with HIV/AIDS. HIV is no longer a death sentence as more people are living healthy and productive lives with the virus. The scaling up of antiretroviral therapy in low- and middle-income countries has transformed national AIDS responses and generated broad-based health gains. The number of people dying from AIDS-related causes began to decline in the mid-2000s and there has been a steady decline in HIV incidence since the peak in 1997. In 2011, 1.7 million people died from AIDS-related causes worldwide, representing a 24% decline in AIDS-related mortality compared with 2005. Worldwide, the number of people (adults and children) acquiring HIV infection in 2011 (2.5 million) was 20% lower than in 2001. The number of children newly infected with HIV is also declining. Moreover, low- and middle- income countries have for the first time made more investment than the global giving for HIV control in 2011 (UNAIDS, 2012).
PCI is committed to combatting HIV/AIDS and continues to contribute to these accomplishments and towards the theme for 2011-2015, Getting to Zero: Zero New HIV Infections. Zero Discrimination. Zero AIDS Related Deaths. Through key approaches such as quality integrated/holistic and community driven programming; identifying and dealing with social drivers including gender inequalities, gender-based violence, and stigma; systems strengthening especially local capacity building of civil society organizations; and strategic targeting, PCI ensures community participation and ownership and the sustainable impact of our HIV/AIDS programs.
Integration with Other Key Sectors for Efficient and Comprehensive Care
Since 2003, PCI has worked closely with the Zambia Defense Force Medical Services to implement an HIV/AIDS prevention program in 52 Zambia Defense Force (ZDF) military units across the 9 provinces of Zambia, targeting ZDF military personnel, their families and civilians in the surrounding communities. With funding from PEPFAR, through the U.S. Department of Defense HIV/AIDS Prevention Program (DHAPP), the program strengthens the capacity of the ZDF to implement effective HIV prevention, care and support activities which include mobile and static testing and counseling, prevention with positives, home-based care and support services for People Living with HIV/AIDS (PLHIV), OVC support and HIV prevention messages and condom use promotion. In recognition of the relationship between HIV infection and cervical cancer, the ZDF HIV prevention program decided to provide cervical cancer screening and treatment services to women, by integrating the service into the existing mobile HIV testing and counseling services.
The cervical cancer screening program was initiated in August 2011, with the aim of increasing women’s access and utilization of HIV testing and counseling and cervical cancer screening and treatment services using a “one stop” service delivery approach. The overall goal of the intervention was to prevent precancerous lesions in women from progressing to invasive cancer of the cervix. The program reached out to women in military camps and those from surrounding civilian communities. By April 2012, of the 1,021 women screened for cervical cancer, 11% were found with abnormal cervical lesions; 66.6% of those found with abnormal cervical lesions were eligible for on-site cryotherapy and were treated immediately, representing 7% of all women screened; and 33.3% of those found with abnormal cervical lesions were referred to the Gynecologic Cancer Prevention Unit at UTH for treatment of more complicated cases, representing 4% of those screened. The prevalence of HIV among women with abnormal lesions was 32%. The prevalence of HIV among all women screened was 24%.
Social Norm Shifting in Gender-based Violence for Reducing HIV Risk
Through its USAID/PEPFAR-funded Social Mobilization to End Gender-Based Violence project in South Africa, PCI is spearheading a cross-sectoral effort to affect the norms that give rise to and sustain physical and sexual violence against women which put them at increased risk of HIV infection. The project has been recognized by USAID for its “bold, well-conceived, and evidence-based strategies” that have reached 3.6 million people.
Community mobilization efforts led by PCI and local partners drove the creation of an innovative new social movement, Prevention in Action, to create and sustain a new norm of action in response to violence against women. The movement includes 12 public and civil society sector partners across the two provinces. Prevention in Action currently has 90 active Community Engagers, over 4,000 Community Influencers in KwaZulu-Natal and 2,000 Community Influencers in Western Cape who have attended all 5 training sessions and have the tools and knowledge to take safe, effective group action to their communities to prevent violence against women in ways that are relevant, acceptable and unique. Up to 60,000 Prevention in Action group members are potentially active in the movement. PCI’s social mobilization model re-enforces engagement, amplification communication, and social action to engage many segments of society in an effort to change social norms that keep violence against women alive. Based on evidence, PCI and partners believe that appropriate actions, in sufficient number at the community level, will lead to a ‘tipping point’ where violence against women is consistently addressed when it occurs, and where prevalence of violence against women declines over time as primary prevention becomes the norm.
Integrated, Person-centered TB and TB-Comorbidities Care
Through its USAID-funded SOLUCIÓN TB (Strengthening Observed therapy Linking Up Community based Integrated Outreach Networks for TB control) program , PCI focuses on community-based TB prevention and control by employing advocacy, communication and social mobilization (ACSM) strategies to target and deliver treatment to the most at risk populations across 13 high priority states in Mexico. PCI also works closely to provide technical assistance to the Ministry of Health, state and jurisdictional partners on expanding ACSM activities across the nation, increasing adherence to treatment, and decreasing stigma and discrimination. The Solución TB program (STBE) has resulted in an average cure rate in the 13 participating states of 90.7%, compared to a national rate of 84.1%.
The fourth phase of SOLUCION TB Program (also called STB4), started on October 1st, 2010 in five states (Baja California, Chihuahua, Nuevo Leon, Tamaulipas and Jalisco) and focuses on tuberculosis (TB) and co-morbidities (HIV and Diabetes). PCI/STB is collaborating closely with the Ministry of Health (MOH) of Mexico through its implementing programs: the National TB program (NTP), the national center for HIV/AIDS (CENSIDA) and the Elderly/Adult program which manages diabetes (DM) control. STB4 works with two different target populations: health providers and affected individuals who are at the center of the design, to promote integrated, person-centered services. The health providers are mainly supported through capacity building and follow up of detection activities. Affected persons receive direct support in information, orientation and diagnosis of TB/HIV or TB/DM. In addition, four state/jurisdictional level implementation plans and 37 coordination meetings took place at the state or jurisdictional levels to improve collaboration between the three programs (TB, HIV, and DM).
Health Systems Strengthening Through Building Capacity for Quality HIV Testing
PCI has been implementing the CDC-funded PRATIBHA (Project for Accelerated Technical Assistance and Integrated Capacity Building for HIV/AIDS) since September 2009 in India. The main objective is to provide technical assistance to HIV laboratories at national and state levels in improving quality systems and processes using standard guidelines. This is done in collaboration with the National AIDS Control Organization (NACO). The approach involves assessments of laboratories with trained assessors following which improvement processes are developed and implemented. The processes include on-the-job training, mentoring, coaching, and supportive supervision. Several tools including posters, handouts, manuals, and guidebooks were developed to support the improvements in quality. Technical exchanges both intra-country and internationally were also undertaken. This has led to accreditation of one (1) laboratory whilst ten (10) are far advanced in the accreditation process and would soon be accredited. An additional five (5) laboratories have also entered the accreditation process.