HIV Case Management Project
Dates: September 2021 – March 2022
ASHM International has recently completed an HIV case management strengthening project in Timor-Leste as part of The Global Fund’s Sustainability of HIV services for Key Populations in Asia (SKPA) Program.
From September 2021 to March 2022 ASHM International was contracted for this project by AFAO (the Australian Federation of AIDS Organisations), the principal recipient for the SKPA multi-country grant, and Estrela+, a national not-for-profit membership association of people living with HIV in Timor-Leste. SKPA’s primary aim is to promote sustainable HIV services for key populations, at scale, to stop HIV transmissions and AIDS related deaths by 2030. In Timor-Leste, strengthening the counselling and case management elements of the HIV treatment and care cascade for improved linkage to long-term care was identified as a key area for support.
“Gaps were also identified along the HIV treatment cascade. Linkage to treatment was found to be patchy due to limited counselling and support services, as well as high stigma. ART services are poorly documented and systems are weak, which results in avoidable stock-outs and patients lost to follow-up. As a result, ART outcomes are generally poor, including drop-outs, treatment failures and high mortality. Gaps and weaknesses were also identified for TB/HIV and STI services.” - 2019 Mid-Term Review (MTR) of Timor-Leste’s national-level Global Fund grant implementation
3 key objectives for the project were identified by Estrela+, the Ministry of Health (MOH), KP communities and World Health Organization (WHO):
- Strengthening existing implementation of HIV Community-based Testing (CBT)
- Improving linkages between testing and case management to improve treatment adherence, and
- Improving lost to follow-up (LTFU) tracking mechanism
ASHM International implemented a team-based approach to meet the project objectives by engaging an Australian-based clinical consultant with extensive experience in Timor-Leste, a Timor-Leste based national clinical consultant with experience in general practice and sexual and reproductive health, and an Australian-based senior project officer with extensive experience in Timor-Leste to provide project management and coordination.
Topics were chosen according to a priority needs assessment involving a range of personnel including Ministry of Health counsellors, HIV peer counsellors, ART Centre healthcare workers, and laboratory technicians. The Handbook’s development was also informed by two key documents - the HIV Stigma Index Report Timor-Leste 2017, and the Report on Loss to Follow Up in Timor-Leste 2021 – as well as WHO guidelines and global evidence from HIV research.
The information in the Handbook was peer reviewed by professionals including infectious disease clinicians, mental health specialists, social workers, and gender-based violence prevention experts. Additionally, the Tetum version received multiple reviews by Timorese experts in their field.
Development of a Counselling and Case Management Handbook
- A practical reference tool for identifying and supporting PLHIV in Timor-Leste. It has a strong focus on counselling, supporting PLHIV to manage their own health, and minimising the HIV-related stigma and discrimination that limit the effectiveness of healthcare services
- Handbook content was translated into Tetum, with a focus on clear and simple language
- A Timorese graphic designer to created illustrations for the handbook to be locally representative, visually engaging, reinforce key messages, and increase the use of the handbook
A Strengthened Referral Pathway
Together with stakeholders, the gaps where PLHIV are at risk of becoming Lost to Follow Up through existing referral mechanisms were identified. A clarified referral pathway was developed with clearly defined roles and responsibilities, including an alternative pathway when same-day active referral is not possible. This pathway appropriately reflects the local context and was embedded within the HIV Case Management Handbook for future training.
Future Project Sustainability
A number of future applications for the handbook were identified in consultation with the Ministry of Health and Estrela+. Additionally, the Handbook provides a useful starting point for future collaborative work which may include:
- Reinforce the key messages in the handbook through follow up training, regular communication and mentoring support to counsellors
- Future versions of this handbook may also include additional topics such as:
- HIV Self Testing
- Syphilis and Hepatitis B, for PMTCT triple elimination
- Understanding Key Populations
- Sexual Orientation, Gender Identity, Gender Expression and Sex Characteristics
- Mental health screening tools
- Responding to Violence
- Development of a separate but complimentary HIV Clinical Case Management Handbook to serve as a reference to medical staff prescribing Anti-Retroviral medication
Introduce a Community Led Monitoring model to engage key population communities in improving the quality of HIV services (and build their trust), introduce structures of accountability into health services, and empower the community to have a voice
Acknowledgement of partners and donors: AFAO; Ministry of Health, Timor-Leste; The Global Fund; Estrela+ Timor-Leste
Document link :
English - TL_HIV_ENG_v1 FINAL.pdf
Tetum - TL_HIV_TL_v1 FINAL.pdf
Supporting Triple Elimination in Papua New Guinea and Timor-Leste (STEPT) Project
Dates: July 2022 - June 2024
Building on the work of previous projects in Timor-Leste, ASHM International is looking forward to working with the National HIV/AIDS Program and the Department of Maternal and Child Health at the Ministry of Health, Timor-Leste to implement a Triple Elimination project. The project will work toward the elimination of mother-to-child transmission of HIV, Hepatitis B and Syphilis in Timor-Leste.
More details to come.
Acknowledgement of partners and donors:
The Supporting Triple Elimination in Papua New Guinea and Timor-Leste Project (STEPT) is delivered in partnership with the Australian Government through the Australian NGO Cooperation Program (ANCP) and with support from ASHM Members.
Integrated Biological and Behavioural Surveillance - IBBS Survey
Dates: 2015 – 2016
ASHM was contracted by the Ministry of Health, Timor-Leste to conduct the Integrated Biological and Behavioural Surveillance (IBBS) Survey among Female Sex Workers and Men who Have Sex with Men, the most at risk populations for HIV in Timor-Leste, in two districts – Dili and Bacau. This project supported national strategic planning and primarily aimed to track the HIV epidemic, monitor sexual risk behaviours, and to measure access to intervention programs in responding to HIV.
Acknowledgement of partners and donors: Ministry of Health, Timor-Leste; UNFPA
Training of healthcare workers at Marie Stopes Timor-Leste
Dates: July 2018 - March 2019
ASHM was requested by Marie Stopes Timor-Leste (MSTL) to deliver a four-day training for ten clinical providers (doctors, midwives, nurses) focused on:
- Voluntary Confidential Counselling and Testing - HIV and Syphilis
- A STl syndromic management update
- Providing SRH counselling and services, including family planning, for PLHIV
Additionally, ASHM supported MSTL with a three-day mentoring visit six-months post training. The training resulted in the development of a short STI handbook for MSTL’s clinical staff as an enduring reference.
Acknowledgement of partners and donors: