JSI Staff Join COVID-19 Community Screening in South Africa
June 29th, 2020 | News
June 29th, 2020 | News
With the world’s largest population of people living with HIV, a high TB infection rate, and a heavy burden of non-communicable diseases, South Africa took decisive measures to protect its population in the face of the COVID-19 pandemic, implementing one of the most stringent and comprehensive lockdowns in the world on March 27, 2020.
While many countries have chosen similar strategies to curb spread of COVID-19 and allow the health sector time to prepare, South Africa took its public health response to the next level, deploying over 20,000 community health workers. Mounting a large-scale, door-to-door screening program—recruiting, training, and equipping staff, designing reporting and supervision systems, and setting up supply and referral logistics—would normally take months. Instead, the National Department of Health (NDOH) leveraged U.S. government-supported HIV epidemic control programs by redeploying thousands of HIV clinical and outreach staff in a matter of weeks.
With support from the Meeting Targets and Maintaining Epidemic Control (EpiC) Project funded by PEPFAR and USAID, nearly 170 JSI HIV prevention program staff have joined this effort. Clinical staff and community mobilizers normally focused on voluntary male medical circumcision (VMMC) fanned out across their target areas. In Zululand District, staff go door to door screening households, while in Gauteng District, they go to taxi ranks, shopping centers, and other community structures. In eThekwini, screening is done at health facilities. Staff use the national COVID-19 screening reporting app, recording GPS coordinates to avoid duplication and facilitate contact tracing and follow up. Health care workers screen people for the most common COVID-19 symptoms.
Anyone who has two or more symptoms must go to a designated COVID-19 testing facility, and JSI arranges safe client referral. Health care workers also screen for other illnesses and identify whether any household is distressed or in need of support. Given South Africa’s HIV and TB vulnerability, screeners also distribute condoms and check whether clients have enough of their medication (ARVs, anti-TB medication, etc.). Though lockdowns permit people to seek care or travel for medical issues, many countries have observed decreases in health-seeking behavior and disruptions in treatment for chronic illnesses. This additional safeguard is vital to protect South Africa’s gains in HIV epidemic control.
By the end of the first month, JSI EpiC staff had screened more than 44,000 people for COVID-19, referring 800 people to designated testing facilities. Community health workers (CHWs) have endured the usual challenges of outreach work: community misconceptions occasionally leading to resistance; hot weather and long hours; expectations for food parcels or other social support; and even encounters with stray animals. Nevertheless, many of these staff are HIV programming veterans with experience putting people at ease and dispelling myths and misconceptions. Moreover, in keeping with USAID and NDOH guidance, they are implementing “no-touch” screening to minimize transmission risk to clients and staff. As a result, they have achieved a high rate of community cooperation, with less than 1% declining the service.
This initiative demonstrates how PEPFAR’s global HIV investments have fundamentally strengthened health systems. As experienced implementers, we can pivot quickly, protecting HIV epidemic control gains while also leveraging our learning and skills to mount complex programs to respond to COVID-19 in record time. We are all anxious to get back to our pre-COVID-19 lives and JSI’s EpiC project staff are keen to return their clinics and core focus: preventing HIV transmission across South Africa by offering high-quality VMMC services. Until that day, we will continue to deploy our public health skills where they are needed most.