| 4. In which ways is the initiative creative and innovative?
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LMC-HACT uses eye-catching leaflets, tarpaulins and promotional materials. We have videos and audio-visual presentations in English and in Filipino. We often use Filipino language during lectures and counselling, so that the participants and clients will understand the topic better. We always encourage the audience to participate and to know their HIV status and the ways of HIV prevention.
Laguna Medical Center was the first healthcare facility to have a functional HIV and AIDS Core Team in the province. LMC-HACT became the model in rendering HIV services and was awarded as the “Best Performing HIV and AIDS Core Team in CALABARZON” in 2015. LMC was the first LGU hospital in CALABARZON to be a DOH-Designated HIV and AIDS Treatment Hub.
In order to attain a responsive healthcare system, the gap between health workers and the community were addressed through information dissemination in different barangays and the implementation of Community-Based Screening (CBS) for HIV. Pagsanjan was the venue of the “pilot project” for CBS in Local Government Unit (LGU) empowering the Barangay Health Workers (BHWs) and Peer Educators to do the CBS and to empower the community to eliminate their fear on getting testing for HIV.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The HIV program is implemented in the province of Laguna under the leadership of Honorable Governor Ramil L. Hernandez. The province has a total population of 2, 669,847 as of May 2010, with an annual population growth rate of 3.11 percent.
Laguna Medical Center is a 200 bed capacity tertiary hospital located in Sta. Cruz Laguna, adjacent to the Provincial Health Office and the Social Hygiene Clinic. It has more than 400 employees rendering healthcare services to the residents of the four (4) congressional districts of Laguna.
LMC-HACT, under the supervision of Dr. Rene P. Bagamasbad (PHO II), Dr. Edgar M. Palacol (Medical Center Chief) and Dra. Donna Catherine I. Ortiz (Treatment Hub Physician) is providing confidential and comprehensive counseling, testing and primary care to HIV clients and other members of the community. Members of LMC-HACT often serve as facilitators in different trainings and advocacy activities in different municipalities.
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| 6. How was the strategy implemented and what resources were mobilized?
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The active implementation of the HIV program in Laguna Medical Center started in November 2014 by creating the HIV and AIDS Core Team of the hospital. It was named LMC-HACT (Laguna Medical Center HIV and AIDS Core Team) with a primary objective of providing safe, confidential, comprehensive and compassionate care for people living with HIV, and for people with risk factors and AIDS defining condition. It aimed to use the hospital resources in minimizing the impact and spread of HIV infection through voluntary and provider-initiated counseling and testing, and proper implementation of standard precautions.
Designation and orientation on the duties and responsibilities of the HACT members, setting up a HACT office, preparation for HIV laboratory accreditation and formulation of policies and procedures were done.
For capability building, several trainings on HIV 101, Sexual Orientation, Gender Identity and Expression, HIV Counseling and Testing, HIV-Proficiency for Medical Technologist, Primary Care, HACT Workshops, Antiretroviral Therapy and Adherence Counseling were done. Regional and provincial multi-sectoral forum were also conducted. Resource speakers are from DOH and LMC, other technical and financial support for their activities were provided by DOH-National STI and AIDS Prevention and Control Program (DOH-NASPCP), DOH Region IV-A (DOH RO IV-A) and the Provincial Health Office.
Different advocacy activities like symposium, large group discussion, booths, fun run, pageants, parade, poster-making contest, and quiz bee involving the youth and other sectors in the province were organized and were funded by the Provincial Government of Laguna (PGL), and by the different Sangguniang Bayan. Condoms, lubricants, leaflets, posters, and other promotional materials were given by DOH and PGL.
After a series of evaluation and validation of the capability and services of LMC-HACT such as counseling, testing and clinical management, LMC-HACT became a DOH-designated treatment hub in May 2016. Comprehensive, compassionate and confidential HIV counseling, testing and linkage to care are done in the treatment hub. DOH-trained treatment hub physicians, nurses, pharmacist, medical technologist and counselors are in-charged in providing such services. The rigid training was funded by DOH and the provincial government.
The pilot project of “Community-Based Screening for Local Government Unit” which started on November 8. 2016 was implemented in Pagsanjan, Laguna. The training for Barangay Health Workers (BHWs), peer educators and Rural Health Unit employees were conducted and funded by DOH-NASPCP, Research Institute for Tropical Medicine – AIDS Research Group (RITM-ARG), The Project Red Ribbon (TRR) and the Sangguniang Bayan of Pagsanjan. As a treatment hub, Laguna Medical Center plays a vital role in terms of linkage to care.
Antiretroviral drugs, medicines for opportunistic infection, HIV test kits, syphilis test kits and CD4 cartridges were supplied by DOH-NASPCP. Other diagnostic procedure, medications and vaccines were provided by the Provincial Government and Phil-health through the Out-Patient HIV and AIDS Treatment Package. Technical support were also provided by the Philippine Business for Social Progress (PBSP).
Monthly reports such as the number of clients tested for HIV, case detection, anti-retroviral therapy eligibility, and mortality were submitted to the Epidemiology Bureau. All activities regarding the HIV Program were regularly monitored by DOH-NASPCP, DOH-RO IV-A, and the Provincial Health Office.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The members of the HACT headed by Dra. Donna Catherine I. Ortiz as HACT Chairman, and under the supervision of Dr. Rene P. Bagamasbad (PHO I), and Dr. Edgar M. Palacol (Medical Center Chief) proposed the activities and trainings to improve the services for people living with HIV and key affected population. The proposed activities were presented to the Department of Health and to the Provincial Government of Laguna, headed by Governor Ramil L. Hernadez. The activities were approved and implemented.
Other stakeholders are the World Health Organization, DOH-NASPCP, DOH RO IV-A, SangguniangPanlalawigan, Sangguniang Bayan, SangguniangBaranggay, Laguna Medical Center, Provincial Health Office, government and private hospitals, rural health units, Philhealth, Department of Education (DepEd), Commission on Higher Education (CHED), Provincial Social Welfare and Development Office (PSWDO), Philippines Business for Social Progress (PBSP), The Project Red Ribbon (NGO), Laguna Tourism, Arts, Culture and Trade Office (LTCATO), Youth Development Affairs (YDA) Office, members of people living with HIV (PLHIV), members of the LGBT community and other key affected population.
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| 8. What were the most successful outputs and why was the initiative effective?
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The initiative of Laguna Medical Center made a tremendous improvement in the HIV program implementation in the province. LMC was able to create an active and functional HACT providing safe, confidential, comprehensive and compassionate care for people living with HIV, and for people with risk factors and AIDS-defining condition. LMC was able to use the hospital resources in minimizing the impact and spread of HIV infection through voluntary and provider-initiated counseling and testing, and proper implementation of standard precautions.
To sustain the HIV services, employees of Laguna Medical Center were oriented on HIV 101. Selected employees underwent HIV counseling and testing training, HIV proficiency training for medical technologists, primary care training for physicians, and antiretroviral therapy and adherence counseling training. Employees of Laguna Medical Center were empowered to render healthcare services to HIV clients without any fear nor hesitation.
Advocacy activities conducted in different areas in the province such as cultural center, municipal halls, barangay halls, schools, plaza, and resorts increased the awareness of the residents on HIV and AIDS. Stigma and discrimination were eliminated. Many of them were encouraged to undergo HIV counseling and testing. The participants were also able to share their knowledge to their peers and relatives.
An increase in the number of advocacy activities resulted to an increased number of HIV testing and case detection. The accreditation of Laguna Medical Center as an HIV treatment hub uplifted the quality of healthcare services in the province. Linkage to care and antiretroviral therapy were immediately provided by the treatment hub physician and nurse, thus improving the health and emotional status of the people living with HIV and their relatives.
Laguna Medical Center together with DOH-NASPCP, RITM-ARG, The Project Red Ribbon and the Municipality of Pagsanjan were able to bridge the gap between healthcare workers and the community through the implementation of the pilot project for Community-Based Screening for HIV in Local Government Unit. The said project empowered the Barangay Health Workers and peer educators to do community-based screening in different barangays, commercial establishments, schools and houses. The fear of the residents for HIV testing were eliminated through proper information dissemination.
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| 9. What were the main obstacles encountered and how were they overcome?
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Availability of funds and human resources were the concern before the implementation of the HIV program in Laguna Medical Center. Fortunately, after presenting the proposed activities, the Department of Health, the Provincial Government of Laguna and the Provincial Health Office allotted a budget for the trainings of the staff. Laguna Medical Center was also able to create the LMC-HACT with dedicated members to render HIV services to the residents of Laguna and nearby provinces.
Stigma and discrimination, and the resistance of the community to address issues on HIV and AIDS challenged the LMC-HACT. Through the LMC-HACT’s initiative to reach out to the people, we were able to bridge the gap between the healthcare workers and the community. Different advocacy activities were done, and the community-based screening for HIV was implemented.
Promotion of HIV services in Laguna Medical Center was first difficult, but through multi-sectoral forum and other interesting activities, we were able to strengthen the referral system, and was able to formalize the Laguna AIDS Council. All the opportunities from the government and private sector of the society were utilized.
Linkage to care, provision of anti-retroviral therapy, compliance, monitoring, availability of medications for opportunistic infections, vaccines and diagnostic procedures challenged the treatment hub physician and nurse. But with the trainings and support from DOH-NASPCP, PBSP and the Provincial Government, the Laguna Medical Center was able to provide excellent services to the community especially for people living with HIV.
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