PEPFAR is the President’s Emergency Plan for AIDS Relief, the U.S. Government initiative to turn the tide of the HIV/AIDS epidemic around the world. This historic commitment is the largest by any nation to combat a single disease internationally. PEPFAR investments also help alleviate suffering from other diseases. PEPFAR is driven by a shared responsibility among donors and partner nations to make smart investments to save and improve lives.
In Cameroon, PEPFAR began in 2009-2010 and has since grown to an annual budget of about $26 million. The initiative is administered by the U.S. Centers for Disease Control (CDC), the U.S. Agency for International Development (USAID), the Departments of Defense (DoD) and State (DoS), and the Peace Corps. About 15 Cameroonian and international implementing partners conduct field activities, often in collaboration with local sub-partners, in the areas of prevention of mother-to-child HIV transmission (PMTCT), prevention of sexual HIV transmission, blood safety, HIV testing and counseling, HIV care and support, laboratory strengthening, strategic information, and other health systems strengthening. All PEPFAR investments are aligned with Cameroon’s National HIV/AIDS Strategic Plan and work to strengthen the capacity of Cameroon’s government, non-governmental and private sectors, and civil society to respond to the HIV/AIDS epidemic.
PEPFAR Success Stories in Cameroon
Soldiers Support Groups
In Cameroon, support groups help soldiers live positively
Sgt. Kristian Kombo, a 36-year-old soldier in the Cameroonian army, was tested HIV-positive in 2008. His father, diagnosed with HIV two years earlier, had kept his status secret, but when Kristian’s wife told him of his son’s diagnosis, he called Kristian and encouraged him not to give up on life.
The response from his colleagues was less supportive.
“Each time I approach the job site, they will quickly say to me, ‘How is your health? You are sick, you don’t need to come to the job site, just go back home and have a rest,’ ” Kristian says. “They did not bother to consider that I instead needed to be in the presence of people. Finding myself always alone, I started nursing the thought of abandoning the job and returning to the village.”
Kristian’s boss repeatedly noted ”Sick and not fit for internship” in his records, blocking any hopes of promotion.
“Each time my children see other soldiers celebrating their promotion they will ask me, ‘Papa, why are you never being promoted?’ and I will feel so bad,” says Kristian, whose wife and two kids have tested HIV-negative.
In June 2012, Kristian took part in a positive-living training for a support group (“groupe de parole”) organized as part of a PEPFAR/DOD-funded project targeting military personnel and their families in the 1st and 3rd Military Regions. Implemented by Population Services International and sub-partner Association Camerounaise pour le Marketing Social, the project aims to reduce HIV infections and improve positive life in the Cameroonian defense forces.
From July 2012 to June 2013, the project organized eight voluntary counseling and testing campaigns in six project sites, testing 3,757 uniformed men and 848 civilians, and created support groups in Garoua and Yaoundé.
Joining a support group is the best thing that ever happened to him, says Kristian, who now serves as vice president of the Garoua group.
“I must testify that it is thanks to the experiences shared in the support group that I gave up the project of abandoning my job and going to stay in the village,” he says. “As even one of my peers said to me, ‘You still have a salary, and your children are in school. Do you really think you will be at ease in the village with the lack of ARVs, necessitating you to always travel to the city in order not to go out of stock?’ ”
Kristian has been on antiretroviral therapy (ART) since 2010. His father became seriously ill in 2010, and it was only then that his children saw in his medical records that he had been diagnosed with HIV. Kristian’s father died in 2010 without ever being placed on ART.
“I was extremely touched by the departure of my father,” says Kristian, who believes that his dad would still be alive if he’d had the support of a group. “I asked myself the question, ‘Why cut down a tree when it can still be fruitful?’”
P-I-M-A spells access to care for pregnant women
Dorothy is 22 years old and pregnant. Like many women in Mundum in rural northwest Cameroon, she discovered her HIV-positive status during antenatal care, in January 2013. Though at her third pregnancy, Dorothy never tested for HIV during her first two, “because no services were offered at the nearby facility,” she says.
Dorothy is not married and relies on the sale of coco yams to care for herself and her two children. When she learned of her HIV status, she felt that her world had come to an end.
Several weeks of denial followed. Getting a CD4 count test – needed to determine the best care for Dorothy and the best way to prevent her from passing the virus to her baby – would have required her to travel to Bafut, 25 km away, and pay $10-$15 for the test, then return days later to get the results.
“I was worried about the extra burden a sick child will bring on me,” Dorothy says, “but I did not have the money to pay for the test, too. Also, at that time I was still under shock and so was not ready to do the long hours of trekking right up to the hospital in Bafut for the test.”
But when a peer educator told her that a mobile CD4 count machine would arrive “on her doorstep” – at a health facility five minutes’ walk from her home – Dorothy decided to go for the test.
Both the peer educator and the mobile new PIMA CD4 count technology are supported by a PEPFAR/CDC-funded project expanding PMTCT activities in the Northwest and Southwest regions of the country. Implemented by the Cameroon Baptist Convention Health Board (CBCHB), the project has installed 38 PIMA devices in 19 districts. Health staff also take the easy-to-transport, easy-to-use machines to provide mobile CD4 testing in hard-to-reach areas.
As a result of making this critical test free and accessible, uptake of CD4 is increasing. Between January and September 2013, the number of people receiving CD4 count services more than tripled from the year before, from 1,276 to 4,171, in the project’s intervention zones.
For Dorothy, it was a surprise to have test results within 20 minutes, allowing medical staff to proceed with proper prophylaxis. Motivated by her experience, she had her children – ages 3 and 5 – tested for HIV when a mobile testing and counseling team came to Mundum. When their HIV-negative results were presented to her, she heaved a sigh of relief and burst into tears, exclaiming, “This is a miracle!”
Bikers for Health
Bikers for Health deliver improved mother-child care
As soon as motorcyclist Michael Tseh arrived with the package, nurse Rhoda Akpan opened it, then picked up her phone to call Akwa Issabella, one of her HIV patients: “Akwa, I have good news for you.” Within minutes, Issabella was at the health center and had the news: Her baby was HIV-negative.
“I am very happy,” she shouted, “grateful and thankful to God.”
Few deliverymen are as anxiously awaited as Michael Tseh, a Biker for Health engaged by a PEPFAR/CDC-funded project expanding PMTCT activities in the Northwest and Southwest regions of Cameroon, implemented by the Cameroon Baptist Convention Health Board (CBCHB).
Like Issabella, hundreds of HIV-positive women in the project’s intervention zone wait while their infants’ dried blood spot (DBS) samples are sent for testing at a reference laboratory 330 km away. In the past, getting results took two to three months. With Tseh providing the link from the local health center in Mankon to the health district and back, Issabella’s took less than a month.
“Bikers have been very useful as they ease follow-up of HIV-positive women,” says Akpan. “DBS samples are carried directly from facilities to the district. When reagents get finished, we get refills without delays. They help carry our PMTCT reports, too, and enable us to get results faster than before, like the negative one I just received.”
The project’s 26 Bikers for Health, whose training included issues of confidentiality, make an average of five trips each per week to collect reports and DBS samples or to deliver DBS bundles or PMTCT commodities. Available whenever the health centers or districts need them, they have reduced turn-around time for the 4,790 HIV-exposed infants tested by DNA/PCR in the project’s two regions over the past 18 months and reduced time from diagnosis to initiation into care or treatment.
Other efforts the project is making to reduce turn-around time include using SMS printer technology installed in district centers to print and deliver PCR results, sending messages via cell phone to notify mothers/caregivers that PCR results are ready, and introducing early infant diagnosis focal points who follow up to ensure that samples reach the reference lab and results are delivered on time to clients.