Ensuring uninterrupted HIV, TB and malaria services in the time of COVID-19

The health community in the Western Pacific is adapting to make sure vulnerable populations are not left behind


A rapid test is conducted with a client inside the Chuuk Women’s Council mobile clinic. Photo: Chuuk Women’s Council.

The COVID-19 pandemic currently sweeping the globe is threatening to derail hard-won gains on HIV, tuberculosis (TB) and malaria, seriously impacting health programmes and causing disruptions to life saving treatment.

In these unprecedented times, national partners of HIV, TB and malaria projects in the Western Pacific, supported by the Global Fund, are adapting and implementing new strategies to ensure vulnerable communities continue to receive the health services and support they need.

Here are four of their stories:


Persevering to reach men who have sex with men and transgender people

Mathew Amituanai sits in full personal protective equipment during an outreach session for men who have sex with men and transgender people in Apia, Samoa. Photo: Samoa Family Health Association.

“I am fortunate enough to be part of a medical community in Samoa that was very aware of the COVID-19 crisis in Wuhan and I have been monitoring its progress since early December,” said Mathew Amituanai.

Mathew is a clinician at a private health centre in Apia and runs an outreach programme known as the MSM Thrive Initiative, which provides HIV and sexually transmitted infections (STIs) testing and counselling for men who have sex with men and transgender people. The initiative is supported through one of UNDP’s national partners, the Samoa Family Health Association (SFHA).

Early in the pandemic, he realized that the continuation of vital sexual health services for marginalized people depended entirely on effective strategic planning.

“I had no doubt that a lockdown here would provide opportunity for increased sexual activities amongst people,” he said. “No one can really monitor what happens in a village and predictably, men who have sex with men, especially the young ones, were reaching out for condoms, lubricants and the chance to be tested and treated.”

The approach he devised was simple: risk stratification in strict compliance with the Government’s regulations.

“The high-risk group comprised of those with flu-like symptoms within the past 14 days and those with travel history, or contact with individuals with a travel history. For these individuals, I made no physical contact. Instead, we caught up using video calls, regular calls and messaging on social media.”

Prevention packages containing brochures, condoms and lubricants were dropped off at agreed locations to avoid physical contact.

The low risk group were people with no history of travel, no contact with those who did and no flu-like symptoms in the last 14 days.

“Every participant was given a mask and had their temperatures taken with an infrared thermometer as an extra precaution before being tested and counselled, while I wore full personal protective gear (PPE), and cleaned and sanitized everything,” he explained.

By chance, Mathew had a ready supply of basic PPE, including N-95 masks, medical gowns, gloves, hand sanitizers and disinfectants. “We recently went through a measles outbreak, in November 2019, so we had a stock already of PPE.” He also managed to source additional supplies, “I am thankful to my friends and family here and overseas for their donations and help in shipping supplies across.”

Participants were gathered in groups of three, with strict social distancing instructions, after which they were dropped off and another three were picked up.

“Public transport was an issue as it was banned, forcing participants to be picked up, but it worked out well in terms of controlling the flow in and out of our outreach site,” he said.

In the end, the programme reached 60 individuals, a number that is frustratingly lower than the typical 100+ people reached per activity.

“I believe it has been a success,” said Mathew. “Many issues close to my heart were unpacked here. We learned a lot about how events can drive increased unprotected sexual activities/STIs, fears that people are experiencing in accessing centralized medical services, violence at home and suicidal ideation. Such things only motivate me to do more, do better and be better. We can always find a way to reach people in need and for those of us who do this kind of work — the onus is on us to find the way.”


The new normal: one-on-one outreach

Sincera Fritz from the Chuuk Women’s Council meets with a client during outreach work on Weno island. Photo: Chuuk Women’s Council.

“The coronavirus (COVID-19) is affecting everyone, from super-powers to the tiniest islands on the planet,” said Sincera Fritz, Key Populations Coordinator at Chuuk Women’s Council. “Our way of life and working has changed. Gatherings are discouraged and social distancing is now the norm.”

Indeed, the new normal is having profound impacts on how the Chuuk Women’s Council can do its work.

A partner of the Western Pacific Multi-Country Integrated HIV/TB Programme, Chuuk Women’s Council works with the Federated States of Micronesia (FSM) Health and Social Services to provide outreach services for vulnerable and key populations. The services provided include HIV and sexual health awareness raising activities, distribution of prevention packages of lubricants and condoms, and community-based testing and counselling for men who have sex with men, transgender people, female sex workers and youths.

The activities are conducted throughout the main island of Weno and the other islands of Chuuk State.

Typically, outreach activities are conducted in group settings, but due to new public health regulations, a new approach was needed to ensure the Chuuk Women’s Council was still able to provide HIV/ STI services to the population in need.

“Our key populations project had to change from group outreach to one-on-one,” explained Sincera, who also represents the Chuuk Women’s Council on the Chuuk COVID-19 Task Force Committee on Education and Awareness. “This is the first time this approach is being put to the test.”

From 27 April to 4 May 2020, the one-on-one outreach approach was trialed on Weno island. Over the eight day period, 61 people were reached, considerably more than the target number of 25. All of the individuals received HIV prevention packages and 57 out of 61 were tested for HIV and syphilis using rapid point-of-care tests.

One of the key elements of the approach was to use a large sports utility vehicle (SUV) as a mobile office/outreach clinic.

“We were able to come to them, instead of them coming to us,” said Sincera. “People expressed their appreciation for the convenience that this one-on-one outreach offers.”

“The mobile outreach clinic really was a great idea — it allowed us to load all of our papers, test kits and incentives into the roomy back of the SUV and stay in the field all day, including weekends and after working hours.”

With smaller groups, they also found that clients were more comfortable to open up and talk about their issues and struggles.

During the one-on-one sessions, Sincera and her team took advantage of the opportunity to also share COVID-19 prevention information.

“If the pandemic continues, which is very likely, these one-on-one activities will be our norm. At this point, we will continue to implement this new approach, and also make use of various internet-based applications to communicate with each other and to support members of key populations groups.”


Taking COVID-19 information and TB services to the people

Health workers prepare to travel by boat during the mission to the Nafe area on Tanna island, Vanuatu. Photo: Ministry of Health.

The extreme weather and terrain in Vanuatu can make getting health services and life-saving information to people a real challenge.

The COVID-19 pandemic is adding another layer of adversity.

During the pandemic, Kevin Carter, a Tuberculosis (TB) Officer, and his team from the Tuberculosis (TB) and Leprosy Programme in Tafea province have been ensuring that despite the obstacles, the vital health services they provide would continue unimpeded.

“We were advised by the central Ministry of Health that our TB programme activities should not be placed on hold,” said Kevin. “The TB programme was one of two programmes that have continued despite the current crisis.”

In late April to mid May this year, Kevin and his team of five embarked on one of their regular missions to remote island communities to conduct TB screenings.

The screenings typically involve mass gatherings in each village, where they raise awareness of TB through community health workshops. Here they screen individuals for TB, as well as their contacts, in alignment with the national TB guidelines, and also manage other health conditions that are detected during the screening process.

Now with the pandemic, things must be done differently. “We had to comply with social distancing measures, so we moved from one household to another rather than having mass gatherings,” explained Kevin. “It was hard to move in such a way but we managed to.”

For the awareness raising community workshops, the team divided the participants into two smaller groups, in an effort to avoid large numbers of people being in close contact. In some cases, the community awareness was done at the family or household level.

A group of participants at an awareness workshop in the Imaki community hold pamphlets they received on COVID-19. Photo: Ministry of Health.

While Vanuatu is one of the few countries in the world with zero confirmed cases of COVID-19, the Ministry of Public Health is taking a proactive approach, knowing that the situation can change rapidly.

Therefore in addition to the TB-focused activities, COVID-19-specific awareness materials were also distributed in each village during the mission.

“We relayed the information to the community whenever we had the opportunity, and translated it into people’s local dialects so they would fully understand and take the message home with them.”

“This is an ongoing crisis and we can’t let our guard down,” said Kevin.


An integrated response to malaria amid COVID-19 and Tropical Cyclone Harold

From 25 May to 2 June 2020, Timothy Takau and his team from the Vanuatu Malaria and Other Vector-Borne Disease Programme embarked on a mission to North West Malekula in Malampa province. Photo: Ministry of Health.

Not only has Vanuatu faced the daunting public health challenges of the COVID-19 pandemic, but also the aftermath of the category 5 Tropical Cyclone Harold that struck the country in early April, causing widespread damage.

The cyclone brought destructive high winds, heavy rainfall and flash flooding, causing widespread damage and loss to the population. The eye of the storm passed directly over Sanma, Penama and Malampa provinces.

Concerns over possible increases in communicable and water-borne and vector-borne diseases, including malaria, prompted the Ministry of Health’s Malaria & Other Vector Borne Disease Control Programme to rapidly coordinate distributions of long-lasting insecticidal nets (LLINs).

“Most of the houses in the provinces affected by the cyclone have been damaged, and the bednets have been damaged also, placing people at risk for malaria,” explained Timothy Takau, a procurement and supply chain management officer with the Malaria & Other Vector Borne Disease Control Programme. “There are also a lot of mosquitoes, and malaria cases have jumped slightly higher compared with the normal amount. So there is an urgent need to distribute bednets to cover those people who don’t have access to them.”

Over a nine-day period from 25 May to 2 June, teams from the Malaria & Other Vector Borne Disease Control Programme embarked on a mission to distribute the LLINs to villages hit by Tropical Cyclone Harold on Malekula island in Malampa province to replace those destroyed or lost during the storm.

They traveled from village to village by pickup truck delivering the bednets and conducting awareness raising activities on how to properly use them, how to protect oneself from contracting malaria, and also on COVID-19.

An elderly woman in one of the most remote villages on Malekula island receives packages of bednets. Photo: Ministry of Health.

According to the Vanuatu COVID-19 Health Sector Preparedness and Response Plan, the country is currently in Scenario 1 — no confirmed cases. Therefore, masks and gloves are not required for LLIN distributions. However, social distancing measures were diligently applied.

“We practiced social distancing at the distribution sites,” said Timothy, who led a team in the North West region of Malekula. “When we registered the names of people in each household for bednets, we didn’t want them to be crowded together, so we asked them to come one-by-one.”

Some of the villages they visited during the mission are extremely remote. The limited communication with the outside world has meant a lack of access to information on the constantly evolving COVID-19 pandemic.

“During the bednet awareness raising sessions, if there were any questions about COVID-19 we provided updates to the villagers on the latest COVID-19 situation and prevention information. This was especially important in the remotest villages where access to communication is not very good,” he noted.

The team was aided by a network of village volunteers. Together, they systematically handed out the nets to the locals and conducted the awareness raising activities.

“Our goal is to ensure there is 100% coverage of nets in the communities, no matter how remote or difficult they are to reach,” explained Timothy Takau, adding: “In this operation, there was no household missed.”

In North West Malekula, Timothy and his team distributed 2,263 bednets, while the overall mission to Malekula island distributed a total of 9,016 bednets.

The Multi-Country Western Pacific Integrated HIV/TB Programme is a regional grant supported by the Global Fund that strengthens control of HIV and TB in 11 Pacific island countries: Cook Islands, Federated States of Micronesia, Kiribati, Nauru, Niue, Palau, Republic of Marshall Islands, Samoa, Tonga, Tuvalu and Vanuatu. UNDP is the programme’s Principal Recipient. To learn more, visit our website.

Ensure 81% Coverage of Long-Lasting Insecticidal Nets (LLINs) in Vanuatu is a three-year (2018–2020) programme supported by the Global Fund and implemented by UNDP in collaboration with the Ministry of Health. The programme seeks to maintain 81 percent coverage of LLINs in the population, ensuring that each household has at least one LLIN, and that all children under 5 years old and all pregnant women sleep under LLINs. For more information, visit our website.