PORT VILA – Since the global HIV response launched in the 1980s, extraordinary public health achievements have reduced new HIV infections and provided access to life-saving treatment. Building on these and to advance the 2030 Agenda for Sustainable Development, the World Health Assembly in 2016 endorsed three global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs). This year’s slogan for World AIDS Day is “Everybody Counts” because universal health coverage means access to effective and affordable HIV services, medicines and other health commodities for all people who need them. The Albion Centre in Sydney, Australia, a WHO Collaborating Centre for Capacity Building and Health Care Worker Training in HIV Care, Treatment and Support, assists in implementing the global strategies and ensuring everyone receives the full range of HIV services, particularly by providing technical support to Pacific island countries and areas.
Since 2016, the Albion Centre has worked with the Vanuatu Ministry of Health to strengthen the capacity of health workers and systems to implement surveillance, prevention, care and treatment of STIs, including HIV.
With a population of around 270 000, Vanuatu is a nation of 83 islands in the Pacific Ocean. The first HIV-positive case was reported in September 2002, and as of June 2015 there have been nine reported cases of people who have tested HIV-positive, six of whom are living. While the number of HIV cases is low, STIs are highly prevalent in Vanuatu. Such circumstances create a context in which HIV could be rapidly spread.
Access to HIV testing in Vanuatu is limited by the nation’s geographically dispersed population, stigmatization of HIV and risk behaviours, logistic limitations including specimen transport and laboratory systems, low relative health literacy, and attitudes of health workers and the general population. Risk factors for HIV transmission in Vanuatu include high rates of STIs, early sexual debut, high rates of adolescent pregnancies and low condom usage. Among people aged 15–49 years, 90% have heard of AIDS, yet only one in five possess comprehensive knowledge. Ten percent of women and 19% of men express tolerance and acceptance of people living with HIV.
Recognizing an opportunity to improve access to effective HIV testing and health services, the Vanuatu Ministry of Health and the WHO Collaborating Centre trained health-care workers in implementing the Vanuatu National Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection (2016). According to the United Nations Development Programme, Vanuatu is the first of 11 countries in its integrated programme to implement and train its workforce in applying the antiretroviral guidelines and HIV prevention.
In August 2017, 16 doctors, nurses and pharmacists attended a three-day training on The Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Vanuatu. Topics included HIV pathogenesis, testing, psychosocial issues, antiretroviral therapy, STIs, engagement in care, prevention and harm reduction. A questionnaire on their knowledge, attitudes and practices was administered before and after the training. Participants reported significant increases in intention to implement the following practices in their workplaces
- ”Patients who present with a sexually transmissible infection will be offered an HIV test.”
- “When taking a medical history, staff (doctors/nurses) will assess a patient’s risk for HIV.”
- “Doctors will give the same quality care to people with or at risk of HIV as other patients.”
- “People taking antiretroviral therapy will be educated about possible side-effects.”
- “A discharge plan will be developed for people living with HIV so that follow-up care in the community is arranged.”
The following is an example of the comments from the training evaluation:
“I would like to congratulate our facilitators for the three-day training. I really appreciate the way they presented the topics – very clear presentations and I have learnt a lot from the different topics and hope to attend more trainings in future about HIV/AIDS and antiretroviral therapy.”
The WHO Collaborating Centre welcomes this opportunity to share expertise with counterparts in Vanuatu and looks forward to ongoing collaboration.