South Sudan is still recuperating from four decades of conflict, but like much of sub-Saharan Africa, the country suffers from a high prevalence of HIV—with an estimated 2.5 percent of the population living with HIV, and higher rates among sex workers and the military. With funding through the U.S. Centers for Disease Control and Prevention (CDC) and from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), ICAP at Columbia University Mailman School of Public Health successfully implemented large-scale programs to test and treat patients living with HIV in South Sudan.
In the six months between October 2016 and March 2017, nearly 14,000 individuals received HIV testing and counseling and more than 1,800 started antiretroviral therapy through ICAP-supported facilities. At one of the largest hospitals in South Sudan, the Juba Teaching Hospital, ICAP alone provides all the support for HIV-related care and treatment.
ICAP currently supports 11 health facilities in five states across South Sudan, providing direct service delivery support, training health care workers, and technical assistance. Over the last year, ICAP and partners have accelerated a number of crisis-responsive interventions to ensure safety for staff and patients and prevent service disruption. These include same-day, same-site initiation of treatment, and a reduction in the frequency of prescription renewals to reduce the number of return trips to the clinic patients need to take.
Even in the face of political crisis and instability in the country, ICAP-supported facilities have been able to retain 70 percent of adults and children on treatment 12 months after the initiation of treatment. In addition, clinics have augmented their HIV services for internally displaced populations. Going forward, ICAP will continue supporting health care facilities and state and national ministries of health to promote and implement a contingency planning exercise designed to sustain HIV care and treatment during periods of increased violence.
Additionally, in the coming year, ICAP will create and strengthen links between the main teaching hospital in the capital and health workers across the country—a strategy already proven successful in Namibia.
A major factor in the success of this work under such tough conditions comes from the productive partnership between CDC and ICAP. “CDC and ICAP have a strong relationship that supports our common goals, and helps achieve our mutual success here,” noted Dr. Shambel Aragaw, technical director for ICAP in South Sudan.
The CDC program in South Sudan, while one of the smallest in terms of staff, is tasked with a large job in a highly sensitive situation. Key to the success of its operation are the four South Sudanese national staff (known as foreign service nationals, or FSNs) whose long-term service forms the backbone of the program and a link between the CDC and ICAP and the government of South Sudan.
“Fighting HIV in South Sudan is very much a team effort,” Dr. Aragaw said. “Given the security challenges, ICAP has limited access to the country. Where we are able to work, we seek to employ South Sudanese health workers to support our efforts.”
For CDC South Sudan country director Dr. Rohit Chitale, the sole American direct hire, the staff’s commitment to the work and knowledge of the local context ensures continuity as country directors rotate in and out. “The FSNs have been trained well in Uganda and the U.K., and they could easily work elsewhere, yet are dedicated to supporting their country,” he says. “We are lucky to have had them for so long.”
By the same token, Dr. Chitale stresses the importance of outside support from PEPFAR and those it funds. “Our continued presence and success in South Sudan is a testament to our partners here—partners like ICAP,” he says. “We are all committed to continuing this fight to bring health care to the people of South Sudan.”