Nyangana District Hospital tracks HIV status of mothers and babies for follow-ups

Rightwell Zulu, or “Dr. Zulu,” as he is affectionately called by his colleagues, is a nurse mentor at Nyangana District Hospital in the Kavango. Together with his colleagues, Veronika Shivute and Felistas Shindimba, they have developed a system that has helped the hospital to test nearly every baby born there to HIV-positive mothers.

Between the start of the tracking system in October 2015 and June 2016, Zulu and his team increased rates of early infant testing from 29.3 % to 94.4 %. The three-nurse team believes eventually they will reach a 100% test threshold.

Zulu and his team aim to start HIV-positive babies on treatment as soon as possible, and keep HIV-negative babies HIV-free. Shindimba, who is the district’s monitoring and evaluation officer, makes monthly visits to outreach clinics.

Shindimba also uses the monthly visits to collect data on HIV-exposed infants. At first, there were many gaps in the data. However, by improving regular communication with mothers, outreach clinic staff, and community health workers, Zulu and Shindimba feel that data quality has greatly improved, and they are able to adequately trace HIV-exposed infants in the Nyangana district.

An important goal for hospital staff is to determine how many HIV-exposed babies are in the district and how many of them are being tested. A baby can contract HIV while a mother is still pregnant, or after birth through breastfeeding, making early infant diagnosis critical.

The system tracks HIV-positive mothers and ensures their babies are tested at six weeks, at nine months, and again at 18 months. As a reminder, prior to each time interval, the team calls each mother, confirming the appointment.

The Nyangana District Hospital provides basic health services to over 38,000 Namibians in Kavango East, including HIV testing, counselling, and treatment. The hospital is also known for its busy maternity ward, and is the sole facility in Nyangana equipped to carry out deliveries.

Zulu and his team developed a detailed procedure that ensures close coordination among the hospital’s nurses and health assistants, outreach clinic staff and community health workers. Their work is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID/Namibia, and implementation is supported by IntraHealth International.

HIV prevalence is highest in the northern regions, including Kavango, which has the third-highest HIV prevalence rate in the country with 23.2 %.

“Sometimes you see that mothers are missing,” Shindimba said. “For example, we might have referred a mother to a certain clinic for her first baby follow-up visit. When we go at the end of December to check the appointment registers, we might see that the mother did not come on her assigned day to that clinic.”

When this happens, Shindimba calls the mother. In cases where mothers can not be reached by phone, she shares the list with community health workers. They are in charge of connecting with mothers at their homes or in their villages, and coordinating with outreach clinics to ensure mothers reschedule their baby’s follow-up visit for HIV testing.