Laguna Medical Center HIV and AIDS Core Team (LMC-HACT)-Treatment Hub
Provincial Government of Laguna

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
A combination of increased risky behavior among Filipinos, low levels of knowledge regarding HIV transmission and prevention, and limited HIV prevention and treatment programs led to a rapid rise in the HIV incidence and prevalence in the Philippines. CALABARZON (Cavite, Laguna, Batangas, Rizal and Quezon) or region IV-A ranked second in the number of HIV and AIDS cases in the Philippines, next to National Capital Region. Due to the limited knowledge on HIV and AIDS, and very few advocacy activities in the province, the members of the community especially the key affected population such as males having sex with males (MSMs), sex workers or people in prostitution, people who inject drugs, overseas Filipino workers and those with multiple sexual partners, are not aware of the different services and they are afraid to be tested for HIV. Also, the clinical and social complexity in providing HIV services hinders the different healthcare facilities in rendering services to people living with HIV and for those with risk factors and AIDS-defining conditions. Although Laguna has a Social Hygiene Clinic which is supposed to be the primary implementer of HIV prevention program, but with certain exceptions, their program primarily targets female sex workers, and do not address the current HIV epidemic among males having sex with males and people who inject drugs. Social Hygiene Clinics are not capable of providing primary care and HIV treatment, which is currently the domain of the treatment hub. As of 2015, there are only 22 treatment hubs in the Philippines. These treatment hubs are already congested, and some patients are complaining due to physical, emotional and transportation issues. Unfortunately, CALABARZON does not have its own HIV treatment hub, and hospital facilities do not have an active and functional HIV and AIDS Core Team who can provide primary care for patients with HIV infection. The difficulty in the accessibility to treatment leads to poor compliance with the medications.

B. Strategic Approach

 2. What was the solution?
All healthcare facility employees should be oriented on HIV and AIDS and selected healthcare personnel should be trained on how to do correct information dissemination, HIV counseling and testing, and primary care to patients with HIV infection, risk factors and AIDS-defining condition. Members of the community should be reached out through information dissemination and advocacy activities so that stigma, discrimination and fear will be eliminated. Participation and dedication of all government agencies, community leaders, private institutions, non-government organizations, volunteers, support groups, and representatives from PLHIV (people living with HIV) community should be encouraged so that all programs on HIV and AIDS will be sustained.

 3. How did the initiative solve the problem and improve people’s lives?
For a healthcare program to be successful and sustained, all initiatives should be started within the organization. Laguna Medical Center was able to organize the hospital HIV and AIDS Core Team (LMC-HACT) composed of physicians, nurses, medical technologist, pharmacist and social worker. With the help of the Department of Health Region IV-A and the Provincial Health of Laguna, the members of the LMC-HACT were trained on HIV 101 and Sexual Orientation, Gender Identity and Expression (SOGIE), we were able to formulate an attention-catching and creative lectures, interesting activities and information, education and communication (IEC) materials. As a roll-out of our trainings, we conducted several batches of HIV 101 and SOGIE seminars for LMC employees. The participants were delighted that they received proper information regarding HIV and AIDS. They were empowered that they can provide healthcare services to HIV clients without any fear and discrimination. After orienting the LMC employees, we also conducted HIV 101 seminars to nearby healthcare facilities including district hospitals, private hospitals and rural health units. We were also invited to conduct lectures in Batangas and Rizal province. After empowering the healthcare facility, we started reaching out to our patients and their relatives. We conducted several lectures on HIV and AIDS in the LMC Out-Patient Department and wards. We distributed leaflets, posters, condoms and lubricants. We also conduct lectures in the community such as municipal halls, barangay halls, schools, plaza and resorts. We also have information dissemination during medical and dental mission, and “Serbisyong Tama Caravans” which are scheduled every Friday in different towns in the province of Laguna. In every activity, we encourage the community to know their HIV status, thus we are offering free HIV testing. We also participated in activities mostly attended by the key affected population such as “LGBT Run, Run Against HIV”, “Mardigay Queen”, “A Talk with the Entertainers”, “Love Revolution for Students”, “Teen Pregnancy Symposium”, “Gender and Development Symposium”, and “Buwan ng Kababaihan”. We actively participated in HIV advocacy activities during the World AIDS Day, HIV Testing Week, and HIV Candlelight Ceremony. To provide a more comprehensive and compassionate care to the residents of Laguna and nearby provinces, we participated in different trainings conducted by the DOH. We have nine (9) DOH-certified HIV counselors, five (5) HIV-Proficient Medical Technologists and ten (10) physicians trained in primary care for HIV patients (pediatricians, surgeons, internists, OB-GYN and anesthesiologist). Two (2) physicians and three (3) nurses were also trained on Anti-retroviral therapy. We are also working hand-in-hand with the Philippine Society of Venereologists, Inc. Laguna Medical Center applied and complied with all the requirements to be accredited as HIV treatment hub. On May 2016, as stated in the DOH Memorandum No. 2016-0188, Laguna Medical Center is officially a DOH-designated treatment hub. A Memorandum of Agreement between the Department of Health and the Provincial Government of Laguna was signed, and a Provincial Resolution was approved. To strengthen the referral system and to enhance the HIV program sustainability, we participated in the different health program coordinators’ meeting, HACT workshops and multi-sectoral forum. The said forum was participated by the representatives from the Department of Health, Philippine Business for Social Progress (PBSP), Provincial Social Welfare Department (PSWD), Department of Education (DepEd), Provincial Health office, SangguniangPanlalawigan, Laguna Tourism, Culture, Arts and Trade Office (LTCATO), Youth Development Affairs (YDA) Office, Provincial Jail, Government Hospitals, Rural Health Units and NGO’s such as the Project Red Ribbon, The Love Project and Shell Foundation. The Laguna AIDS Council and other Local AIDS Council were also organized.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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.
 6. How was the strategy implemented and what resources were mobilized?
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.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.

 8. What were the most successful outputs and why was the initiative effective?
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.

 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Laguna Medical Center HIV and AIDS Core Team – Treatment Hub provided universal access to treatment for HIV and AIDS for all those who need it. It offered assessment, establishment and confirmation of the diagnosis of HIV infection through available and effective diagnostic procedures. The HIV treatment hub provided prevention, treatment, care and support services to people living with HIV (PLHIV), people in prostitution (PIP), female sex workers (FSW), males having sex with males (MSM), people who inject drugs (PWID), and other key affected population through counseling and testing, clinical management, patient monitoring and other support services. The HIV treatment hub become an effective, highly accessible, and responsive treatment hub in CALABARZON committed to reduce the prevalence or prevent further spread of HIV infection and to reduce the impact of HIV and AIDS on individuals, families, sectors and communities. Aside from the prevention, treatment, care, and support services, the HIV and AIDS Treatment Hub provided counseling and literacy program for PLHIV. In this way, they become more aware of their condition, integrate among themselves that sense of empowerment, and lessen their stigma. The HIV treatment hub provided technical assistance to other health facilities and community-based organization in need of professional trainings in the clinical management of HIV infection, and to respond accordingly to referrals from various health facilities and to submit reports to the HIV Registry and Epidemiology Bureau. The impact of HIV program was measured by the number of people oriented on HIV and AIDS and the number of clients tested for HIV. The number of HIV cases detected, reported and linked to care was also a good indicator of the success of the program.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The initiative in actively implementing the HIV program in Laguna Medical Center really enhanced the quality of healthcare services in Laguna. With an effective information campaign, more resources and better public health access to HIV intervention and treatment, many lives were saved and HIV transmission is prevented. Members of the community become aware about HIV and AIDS, and they are encouraged to know their HIV status. Residents of Laguna are not hesitant to go to LMC-HACT office and be tested for HIV because they know that all procedures are confidential. They put their trust in the institution that all information that they will divulge will be kept properly. As a government institution and the first LGU treatment hub in CALABARZON, LMC-HACT is able to offer affordable HIV services to PLHIV and their families, regardless of their economic status. The facility was able to establish multi-specialty referrals and to activate referral system with other existing treatment hubs in the country. The coverage and quality of prevention, treatment, care and support programs for PLHIV were improved. The implementation, management and coordination of HIV programs in all levels were enhanced. Partnerships with other local government unit, private sector, non-government organization and community were strengthened.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The HIV program in Laguna Medical Center is open for all Filipinos seeking information and consultation about HIV, AIDS and other sexually transmitted infections. The establishment of functional HACT and highly accessible treatment hub in Laguna is in response to Section 22 of Republic Act 8504 that stipulates “persons with HIV/AIDS shall be afforded with basic health services in all government hospitals, without prejudice to optimum medical care which may be provided by special AIDS ward and hospitals”. It is also declared that the state shall promote public awareness about the causes, modes of transmission, consequences, means of prevention, and control of HIV/AIDS through a comprehensive nationwide educational and information campaign. Different administrative orders and department memorandum were issued to ensure that all those needing medical management and assistance were given sufficient attention. These include memorandum regarding TB-HIV collaboration, Prevention of Mother to Child Transmission, Reproductive Health, Antiretroviral Therapy and Out-Patient HIV and AIDS Treatment Package.

Contact Information

Institution Name:   Provincial Government of Laguna
Institution Type:   Local Government  
Contact Person:   Donna Catherine Ortiz
Title:   Treatment Hub Physician  
Telephone/ Fax:   049-501-4230;0234
Institution's / Project's Website:  
Address:   30 F. Jamolin St., Famy, Laguna
Postal Code:   4021

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