Summary
VIHeillir is a project aiming at testing strategies to improve health for people living with HIV over 50 years. Integrating screening, diagnosis and treatment of comorbidities in HIV routine care and facilitating prevention and follow up of comorbidities for people over 50 years (with or without HIV) in the community. The project started in 2020 in Cameroon and Senegal, it supports 4 services in the capital cities and 1 in a semi rural site. Simplified protocols and supply of tests and drugs at lower prices for hypertension, diabetes, hepatitis B and C and cervical cancer have been provided. Patients over 50 can be referred to Community Based Organisations where they can participate to activities aiming to facilitate healthy aging: age-adapted sport groups, physiotherapist consultations, culinary workshops to learn food combination and preparation for diabetic people, cardio-metabolic parameters follow up with blood pressure, weight and capillary glycaemia measurements for free.
Planning and Implementation
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What was the challenge you were trying to address?
The main challenge is access to care for older people with chronic conditions. In a health system where payment is based on cost recovery, each single health cost is supported by patients. Elders have often a reduction in income due to reduced time spent working and depend greatly on family solidarity. In chronic diseases, families can be exhausted economically and be obliged to make choices on expenditures priorities, sometime excluding care of chronic diseases especially when these are asymptomatic. Is therefore important for older people and their family to understand the importance of investing in care of NCD but even more to prevent these diseases and their complications as much as possible through adoption of healthy living habits as early as possible. Where schemes of social protection for older people exist (like in Senegal), they may be difficult to navigate and may not be functional enough to overcome access barriers.
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Who were you trying to impact?
Older people in general, Older people with chronic health conditions or disability, Older people with vulnerabilities
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What sectors were you targeting?
Health, Information and Communication
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Who else was involved?
Government, Civil Society Organization, Older People's Association, Health Care
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How did older people participate?
Older people were part of the process at multiple or all stages
Lessons learned
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Please describe how collaboration worked in your initiative.
In Cameroon a civil society organisation (Positive Generation) and in Senegal an academic/research institution (CRCF: Centre Regional de Recherche et Formation à la prise en charge clinique de Fann) were in charge of contacting and mobilising different organisations working with older people or on conditions frequent in this population. They contacted and finally selected the following organisations: - in Senegal: le Réseau National des associations de Personnes vivant avec le VIH (RNP+), le Conseil National des Ainés du Sénégal (CNAS), l’Association Sénégalaise de Soutien et d’Assistance aux Diabétiques (ASSAD), l'Association And Bokk Yaakaar (ABOYA) and l’Association sénégalaise de soutien aux personnes victimes d’AVC (ASP/AVC). - in Cameroon: Association Camerounaise des Diabétiques et Hypertendus (ACADIAH), Jeunes Diabétiques du Cameroun (JDC), Association Santé et Développement (ASD), World Changers International Mission (WCIM), Rassemblement des Fils et Filles de l'Arrondissement de Bafia (RAFFABAF), Notre Modeste contribution (YOHMECAM) et POURQUOI PAS. These associations organise the activities in coordination with the project. In addition, the project collaborate directly with the local Committees to fight AIDS by sharing the data, information on implementation and lessons learned.
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What was the impact of your initiative on older people, their families, and/or their communities?
The project allowed the diagnosis of comorbidities in many older people living with HIV and facilitated the treatment for many of them through price reduction of drugs for high blood pressure and diabetes and free care for cervical cancer. In addition a solidarity fund is available for older people living with HIV who cannot afford to pay for the needed care. The associations working with the project provided information, education and screening to more than 1200 people over 50 years. A Patient, 65 years, attending a sport group at the Association Pourquoi Pas stated: "Having associations that do this kind of activity near us makes our lives easier. Now I know that I can control my illnesses and do my exercise twice a week here for free."
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What issues did you face, and how did you address them?
Some older people living with HIV doubted to attend group activities in community organisations not of persons living with HIV for fear of discrimination and stigma. The referral of older people living with HIV in the community was anonymised and associations were made aware of the importance of confidentiality. At the end, older people living with HIV were very happy to mix up in activities with other elders sharing issues in relation with NCD and healthy living adapted to their age. Transport costs were another challange and we are trying to overcome this through the organisation of activities closer to the people: organising activities in different parts of the city.
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What lessons did you learn from implementing this initiative?
1) Older people are often neglected in public policies (in Cameroon they are not yet among the priority populations for the UHC); 2) Knowledge about non-communicable diseases and healthy living is limited among older people; 3) Little is known on how to better mobilise older people.
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Do you have any other reflections you would like to share?
There is need of more presence of international institutions advocating for older people.