South Sudan: Treating HIV-Positive People Affected by Conflict

For many people in rural South Sudan, HIV testing and antiretroviral therapy (ART) is nearly impossible to obtain, partly because war has forced many to flee to isolated locations where treatment options are limited or nonexistent. But in Yambio County -- in the southwest -- things are different as a Doctors Without Borders/M�decins Sans Fronti�res (MSF) pilot project is providing same-day care to many people living with HIV.

"In the past, there was very little treatment for people living with HIV in the area. The sick just suffered and died," said Arkangelo Ruben, a tribal chief and community leader in the 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."

To address this gap in care despite the immense needs -- HIV prevalence in Yambio is well above the national average at 3.4 percent -- MSF has been running a "Test and Treat" pilot program, with the support of the Ministry of Health, for the past two and a half years. Currently, two mobile teams are running six centers in Yambio's surrounding areas where people are tested and receive ART immediately if they test positive rather than having to return to a clinic.

Getting people who test positive for HIV on treatment immediately gives them a better shot at living long, healthy lives and reduces the chances that they will infect their partners, curbing the spread of the virus.

"Access to lifesaving 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," said Jaume Rado, MSF's head of mission in South Sudan.

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 World Health Organization. The one big difference with this project is that Yambio is that it is in a conflict setting. From time to time the level of violence flares up, leaving populations cut off from the outside world.

Rather than leave it to patients to get themselves to a clinic or dispensary, MSF goes into hard-to-reach communities to test for HIV and provide treatment. "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 patients' lives and community health workers who can even deliver drugs to very isolated places," said Farhan Adan, MSF's project coordinator in Yambio.

The most recent figures are promising; Between June 2015 and the start of November 2017, 14,804 people in this region have been tested for HIV. Of those, 505 tested positive and 401 were enrolled in treatment.

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-centered 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 within walking distance."

As the pilot phase nears its June 2018 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 program to other health providers with the help of the Ministry of Health," Rado said. "Many other communities that have been affected by instability and many displaced people can benefit from what we have developed."