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CAMEROON BAPTIST CONVENTION HEALTH BOARD
AIDS CARE AND PREVENTION PROGRAM 12th September 2007
INTRODUCTION
In 1999, in response to the AIDS pandemic, which threatened to destroy an entire generation, the
Cameroon Baptist Convention Health Board (CBCHB) started a Community AIDS Education
Program. Subsequent data show that Sub-Saharan Africa, including Cameroon, bears 64% of the
world’s HIV burden and 74% of all AIDS deaths. The 2004 Demographic and Health Survey
reported that the HIV prevalence among Cameroon’s 16.3 million people was 5.4%, and the
average life expectancy was 46 years. In February 2000, the US-based Elizabeth Glaser Pediatric
AIDS Foundation (EGPAF) granted CBCHB start-up funds for a Prevention of Mother to Child HIV
Transmission (PMTCT) Program. Cumulative data from this PMTCT Program show an average
HIV prevalence of 8.4% among >200,000 pregnant women. Although lower than those in South
Africa and some other African nations, these prevalence rates rank among the highest in the
world. Therefore, CBCHB has expanded its fight against the pandemic to a comprehensive AIDS
Care and Prevention Program (ACP), which focuses on:
 Prevention
 Treatment of the infected
 Support to the affected
CBCHB is a non-profit; faith based health care organization whose mission includes: “… to assist
in the provision of health care to all who need it, as an expression of Christian love and as a
means of witness….” It comprises two 250-bed hospitals, 24 integrated health centers, 43
primary health centers, pharmaceutical production and distribution, a Private Training School for
Health Personnel, and other critical health services for a population base of 6 million people in six
of Cameroon’s ten provinces. CBCHB works in partnership with governmental and nongovernmental health care organizations in Africa and with multiple international organizations and
funding agencies. The international organizations include USAID, UNICEF, and a US-based
micro-enterprise program, KWIHEED, which sponsors loans for low income women in Cameroon
through WINHEEDCAM (Women’s Initiative for Health, Education and Economic Development in
Cameroon), giving priority to women infected with HIV AND AIDS and foster families that support
AIDS orphans.
CBCHB/AWARE/USAID Partnership
In 2004, the US Agency for International Development (USAID) chose CBCHB to be the Action for
West Africa Region (AWARE) Regional Training Center, because they deemed us to be a model
of “best and promising practices” in PMTCT. The CBCHB PMTCT Program distinguished itself in
West and Central Africa by its unique, grassroots, “bottom-up” approach, its impressive program
uptake by pregnant women, and its rapid expansion. With EGPAF funding, CBCHB had started
PMTCT in February 2000 in 2 health facilities, and by December 2003 were supporting 92
facilities and had screened over 38,000 pregnant women for HIV. AWARE felt these
accomplishments qualified us to train health care providers throughout W. Africa in PMTCT and
reproductive health. AWARE’s support of CBCHB promotes the expansion of PMTCT and
obstetric programs in West Africa through the improvement of knowledge and capacity to
implement them among decision makers, managers, and providers in the 18 countries that
comprise the AWARE region. AWARE’s strategies were to:
 Strengthen the institutional capacity of CBCHB,
 Strengthen CBCHB’s role as a regional learning center and technical resource,
 Work toward the sustainability of CBCHB’s role in the region after the end of the
AWARE support
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AFRICAN MAP = COUNTRIES TRAINED BY CBCHB WITHIN THE PAST 3 YEARS
# OF PARTICIPANTS TRAINED PER
COUNTRY
COUNTRY
Mali
Mauritania
Senegal
The Gambia
Guinea
Sierra Leone
Liberia
Nigeria
Ivory Coast
Niger
Togo
Tchad
Zambia
AT
IN
CBCHB
COUNTRY
1
Mali
4
2
Mauritania
2
3
Senegal
2
4
The Gambia
2
5
Guinea
4
6
Sierra Leone
4
54
7
Liberia
4
27
8
Ivory Coast
5
13
9
Togo
2
10
Niger
4
11
Nigeria
5
12
Tchad
2
13
Zambia
10
14
Botswana
3
15
Tanzania
5
TOTAL
58
Tanzania
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123
Botswana
With EGPAF support
With AWARE support
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AWARE’s reproductive health initiatives include improving obstetric care, providing technical
upgrades and equipment (eg. ultrasound machines, CD4 counters) at practicum sites to facilitate
hands-on learning, training providers in family planning, and providing a wide range of
contraceptive methods. Their PMTCT initiatives include the Men as Partners (MAP) Program to
encourage men to get HIV testing and to foster healthy family relationships; the Client-oriented,
Provider Efficient (COPE) quality improvement program; and training in infection prevention,
facilitative supervision, monitoring and evaluation, marketing, and implementing the Technical
and Organizational Capacity Assessment Tool (TOCAT).
The impact on CBCHB, the community, the country, and the region is enormous. The above
initiatives have been fully integrated into the management system at every CBCHB facility. Staffs
are better motivated, especially as they use COPE and facilitative supervision tools to identify and
solve their problems. In the first 3 years, CBCHB/AWARE trained 123 health care providers from
15 other African countries in PMTCT (see map).
The components of the CBCHB AIDS Care and Prevention Program (ACP) are:
1. Community AIDS Education
2. Prevention of Mother to Child Transmission (PMTCT) of HIV
3. Tuberculosis (TB) Control
4. Orphan Care (“Chosen Children”)
5. Support Groups for HIV-infected men and women
6. MTCT Plus Program (care and treatment for persons with HIV)
7. Youth Network for Abstinence (“YONEFAB”)
8. Adopt a Health Care Worker
9. Contact Tracing and Partner Notification (“Expanded Forum for Care”)
10. Cervical Cancer Prevention
11. Palliative Care
1. The Community AIDS Education Program:
Initially, CBCHB trained a small group of nurses, then an ever-expanding number of volunteer
AIDS educators to speak in schools, churches, and other public forums in their own
communities, where they are familiar with cultural practices and other community-specific
factors that put people at risk of acquiring HIV infection. CBCHB have developed a manual for
Community AIDS Educators (CAEs) for both initial training and continued use as a reference.
CAEs have educated over 2 million people with factual information on HIV AND AIDS and how
to prevent becoming infected (“primary prevention”). The HIV prevalence among pregnant
women under 20 years old decreased significantly (0.25% per year) from 2000 to 2003 in 5
CBCHB facilities, likely due to primary prevention as a result of the Community AIDS
Education Program. This program:
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Disseminates basic information on HIV and AIDS and methods of prevention.
Advocates behavior change as appropriate, to reduce exposure.
Prepares and distributes educational material.
Trains and certifies health educators and volunteers.
Sensitizes audiences through: lectures, role-play, video, etc.
Is funded by CBCHB and Bread for the World.
PMTCT Program:
Since its initial grant in February 2000, EGPAF has renewed and increased grants to
CBCHB each year, with the aim of up scaling PMTCT to cover the entire nation in
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collaboration with the National AIDS Program. CBCHB-supported PMTCT services are fully
integrated with antenatal care clinics and maternity wards. Counselors and midwives
provide group counseling during the 1st antenatal visit regarding all aspects of antenatal
care, including the tests CBCHB offers during pregnancy, with additional specific information
on the HIV test, its implications, and the availability of the antiretroviral drug, nevirapine, free
of charge, to reduce transmission to the newborn by about 50%. Following group
counseling, CBCHB counsels each woman individually and give her the option of accepting
or refusing any of the tests and over 93% accept HIV testing.
CBCHB also supports
PMTCT services in other church, NGO, industrial, and government facilities, by training their
staffs, supplying nevirapine and test kits, and evaluating and monitoring their programs. In
2002, the Life Abundant Primary Health Care Program of CBCHB trained four birth
attendants in remote villages to provide PMTCT services. Now trained birth attendants
provide these services in over 20 primary health centers. In 2003, Prof. Tih Pius Muffih,
Director of Health Services for CBCHB, received an International Leadership Award from
EGPAF; this enabled CBCHB to train leaders and service providers from all over Cameroon
and some other West African countries to be PMTCT trainers. As of July 2007, CBCHB
supported PMTCT services in 352 facilities and had tested >200,000 pregnant women for
HIV. CBCHB is currently partnering with Ivory Coast, Zambia, and S. Africa in a PMTCT
Effectiveness Evaluation to determine how well services reach the population in need,
whether the pregnant women are actually taking their nevirapine in labor, the impact of
PMTCT on childhood HIV-free survival, and the cost effectiveness of PMTCT services.
Specific activities of the PMTCT Program include:
 For women who are HIV infected:
o Treating them and their infants with nevirapine at the time of birth.
o Offering ongoing counseling on safe infant feeding, methods of living positively with
HIV, and appropriate use of condoms to reduce transmission.
o Encouraging them to join support groups.
 For those who are negative:
o Encouraging them to remain negative by maintaining Abstinence, by Being Faithful
to a single faithful partner, or by appropriately using Condoms (the “ABCs”).
3. Tuberculosis (TB) Control Program:
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CBCHB started its TB Control Program in 1999 in response to a growing TB epidemic. HIV
infection makes people more susceptible to TB; Over 60% of TB patients treated at
CBCHB facilities are HIV positive. Under supervision of CBCHB doctors trained in TB
management, the 3 nurses assigned to this program accept referrals from other health
care workers, prescribe TB medications as outlined in CBCHB’s TB Manual, see returning
patients, and provide tracking and follow up. From 1999-2004, Banso Baptist Hospital
diagnosed 1465 patients with TB; 66 % completed treatment, 22 % died, and only 13 %
were lost to follow up.
Specifics of this program include:
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Hospitalizing most new TB patients for 14 days, during which nurses administer
medications, train patients to self-administer medications, and train family members to be
treatment facilitators at home.
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Maintaining a computerized database and tracking system on all TB patients to facilitate
follow-up and ensure treatment adherence and completion.
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Partnering with the National TB Program, which provides TB drugs at no charge to four
CBCHB facilities that are designated TB treatment centers.
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4.
The Chosen Children Program (CCP):
In 2001, CBCHB started this program for orphan care, initially with a small grant from the USbased Firelight Foundation. CCP has received subsequent funding from the North American
Baptist Conference (NAB), the Baptist General Conference (BGC), the Cameroon
government, and private individuals. CCP identifies and registers AIDS orphans and other
vulnerable children and supports them through their foster parents by subsidizing their
education, food, and health care, rather than by building orphanages. CCP also raise
awareness in the communities on the role of foster parents in meeting the needs of these
children and the importance of protecting the legal rights of orphans. CCP has identified over
3000 orphans and supported over 800. The name of the program and the method of giving
support to the family were determined with input from the first group of family caregivers that
were selected and trained. The Chosen Children Program:
 Identifies and registers orphans - especially AIDS orphans.
 Raises funds to support these chosen children through their foster parents.
 Trains foster parents or caregivers on basic skills and legal rights of orphans.
 Helps caregivers obtain micro loans for businesses.
 Encourages communities to assist with caring for orphans.
5. Support Groups:
These are groups of HIV positive women and men, and of family members affected by AIDS
(e.g. foster parents of AIDS orphans) who come together to empower themselves by sharing
experiences and receiving training on living positively with HIV and AIDS. The HIV positive
women’s groups, men’s groups, and family member groups are usually separate entities,
although a few are mixed men and women. Over 70 support groups with over 3,000 members
are, for the most part, self-supporting, with help from CBCHB to meet the medical, psychosocial
and spiritual needs of the members. Support groups:
 Offer training by a nutritionist in improved adult nutrition (including practical food preparation
demonstrations) and in the safest infant feeding options, according to the latest World Health
Organization guidelines: exclusive commercial formula or breastfeeding (no mixed feeding) for
the 1st 6 months, then addition of “complementary” (solid) foods to breast milk or formula
through 12 months, then adding table foods to breast or animal milk from 12 to 24 months.
Before a mom stops breastfeeding, she must assure that replacement feeding is Acceptable,
Feasible, Affordable, Sustainable, and Safe – “AFASS.”
 Encourage members to form work groups that receive loans from WINHEEDCAM for small
business enterprises to generate income. Some groups manufacture and sell powdered
complementary foods from ground maize, soya beans or ground nuts, and commercial infant
formula, to be made into porridge for babies 6-24 months old. A nutritionist from US has
analyzed these foods and developed specific recipes for varying ages of infants to assure
nutritional adequacy.
 Train members in handicrafts and other marketable skills.
 Train members in health promotion and disease prevention, including family planning; offer
referrals for family planning services.
 Assist with medical follow up for members and their infants, including provision of adult and
infant cotrimoxazole prophylaxis, multivitamins, family planning commodities, condoms for
those who are sexually active, periodic CD4 counts, and referral for antiretroviral therapy.
 Provide a strong infrastructure for political activism.
5. MTCT Plus Program:
Started in 2004 through a grant from Columbia University in New York City, this program was
initially a demonstration project to provide care for a total of 750 persons, including pregnant
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women found to be HIV-infected through the PMTCT Program and their infected partners and
children. Additional funding from Columbia enables MTCT Plus to:
 Provide medical follow up for an increasing number HIV infected pregnant women and
their families, including regularly scheduled CD4 counts and other tests and lifelong
antiretroviral therapy (ART) when indicated
 Rapidly expand to five clinical sites: Banso and Mbingo Baptist Hospitals and Nkwen
(Bamenda), Mutengene, and Mboppi (Douala) Baptist Health Centers
 Provide a more effective PMTCT drug regimen in MTCT Plus facilities, using 3
antiretroviral drugs to reduce MTCT to <5%
7. Youth Network for Abstinence (YONEFAB):
 Surveyed 4600 youths regarding their sexual knowledge, attitudes and practices
 Encourages youth to join abstinence clubs and pledge abstinence until marriage, with the
aim of preventing HIV, other sexually transmitted infections, and unwanted pregnancy and
of preserving the intimacy of sex as part of marriage.
 Provides HIV testing at no charge to youth whose parents give permission, HIV and AIDS
education, and other programs for youth abstinence clubs
 Funded by CBCHB and EGPAF
8. Adopt a Health Care Worker (HCW) Program:
 Provides infected HCWs with free ART when they become ill enough to need it
 Encourages them to form support groups
 Supported partly by donations from other CBCHB HCWs, partly from Global Strategies (a
US-based Christian organization), and partly by the MTCT Plus Program
9.
Expanded Forum for Care (Contact Tracing)
To date, there have been few sexually transmitted infection (STI) contact tracing/partner
notification programs in Africa and no affordable tests to accurately diagnose most STIs.
When donated HIV tests became available to test youth in abstinence clubs, CBCHB tested
1,406 young people aged 12 to 26 years and found 22 of 984 girls (2%) and 1 of 422 boys
(0.2%) to be HIV positive (p<0.01). In response to these alarming findings, CBCHB began this
bold, pioneer pilot program to determine:
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Risk factors for HIV infection in adolescents and young adults from the Northwest
Province of Cameroon;
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The acceptability and feasibility of partner notification among HIV positive individuals in
Cameroon;
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How many undiagnosed HIV cases are identified through partner notification;
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Whether high risk male transmitters contribute to the spread of HIV among the youth,
and, if so, what can be done to reduce transmission;
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Whether contact tracing can benefit the contacts by successfully referring them for
appropriate medical evaluation and care.
10. Cervical Cancer Prevention Program
Cervical cancer is the 2nd most common cancer in women worldwide and the leading
cause of cancer death in women in developing countries. Eighty % of the 400,000
worldwide cervical cancer cases diagnosed yearly are in developing countries, where most
women who die from this disease are in their 30s and 40s. Although cervical cancer has
become rare in the US, due to decades of Pap smear screening and treatment of precancers, in developing countries there are still an estimated >1.7 million cases of cervical
cancer and 5-13 million cases of pre-cancer. In 2007, CBCHB began a partnership with
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the University of Alabama’s Cervical Health Program in Zambia, East Africa, which is
pioneering a new method of cervical cancer screening, using digital photo-cervicography
instead of Pap smears (which are neither available nor affordable for most African
women). Although no funds are available for the program in Cameroon, the Zambian
program has provided training both on site and in Zambia for our staff and is the first
African transcontinental internet consultation service for difficult cases. CBCHB also
coordinates with the Cameroonian National Fight Against Cancer in program planning and
patient referral. CBCHB plans a mobile cervical cancer screening clinic, using a large
donated US Army ambulance, to travel to various clinics and support group meetings, with
a priority of screening HIV-infected women, who are at highest risk. CBCHB is developing
expertise in cryotherapy and the loop electrical excision procedure (LEEP) to treat precancers and plan training in radical surgery techniques and cancer staging.
11. Palliative Care
In Africa, patients with prolonged pain from AIDS, cancer, and other conditions seldom
have access to adequate pain management to relieve their suffering. With >800 AIDS
patients on antiretroviral therapy over a 3 year period at Banso Baptist Hospital (BBH)
alone, CBCHB saw a need to establish a palliative care program. In 2005, CBCHB
partnered with, and received training from Hospice Africa, a United Kingdom-funded
palliative care program in Uganda, to begin a hospital and home-based program, initially at
BBH, using modern pain management techniques and medications, including oral
morphine. This is a pioneer program in Cameroon. Hospice Africa assisted in negotiating
with the Ministry of Health to establish the program and to develop WHO-compatible
guidelines and assurance of accountability in the use of opioids. The International
Narcotics Control Board (INCB) ensures countries comply with the Single Convention on
Narcotic Drugs, a treaty (1961, amended in the 1972 protocol) to ensure the availability of
opioids for medical use while preventing any abuse.
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The specific objectives of this program are to:
Control pain and manage symptoms related to HIV and AIDS, cancer, and other painful
illness.
Provide psychosocial support to patients and their families at places most suitable for them
(both in hospitals and clinics, and via home visits).
Provide spiritual support to the patients and their families as part of the holistic approach to
bring them to peace within their own beliefs, before the end of life.
Conduct ongoing training for health professionals and community care volunteers.
Begin a Palliative Care Association initially within CBCHB
The pilot program has been extremely successful, with enrollment of 57 patients in the 1st
6 months. The 2011 strategic plan is to expand the program to 1600 patients in 3 CBCHB,
1 other faith-based and 1 government health facilities, if funding is available.
Interrelation between the components:
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The Youth Network for Abstinence and the Community AIDS Education Programs reduce
new HIV infection rates and bolster PMTCT counseling by increasing people’s knowledge
of HIV, reducing stigma, encouraging behavior change (primary prevention), and
encouraging acceptance of HIV testing.
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PMTCT counselors, the women they counsel, and support group members become, in
turn, unofficial, but effective, CAEs. Some support group members have been trained and
hired as PMTCT counselors.
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The Men as Partners Program encourages partners of pregnant women to be tested and
promotes healthy family relationships to reduce gender inequality and domestic violence.
The PMTCT Program encourages HIV infected pregnant women to join support groups
and refers them to the MTCT Plus Program for evaluation and treatment.
MTCT Plus cares for newly-identified HIV infected pregnant women, some support group
members, and some HIV-infected CBCHB health care workers.
The Infection Prevention Program assures that hospitals and clinics do not perform unsafe
practices that could expose patients to HIV and provides HIV testing and post-exposure
prophylaxis to employees with occupational exposure.
The Adopt a Health Care Worker Program cares for employees who are not covered by
MTCT Plus, thus helping maintain the critical health care workforce.
Infants and children who are orphaned by AIDS or other causes are registered as Chosen
Children and are eligible for benefits from that program.
Caregivers of Chosen Children participate in support group meetings.
The PMTCT and MTCT Plus Programs screen pregnant women for TB and refer those
who are positive to the TB Control Program for treatment and follow up.
The TB Control Program screens patients for HIV and refers those who are positive to
support groups, MTCT Plus, Adopt a Health Care Worker, or CBCHB physicians for follow
up and treatment.
WINHEEDCAM provides micro-enterprise loans to support group members and foster
parents of orphans to empower them to raise their income.
The Cervical Cancer Prevention Program has prioritized screening support group women,
who are at higher risk of cervical cancer.
The Palliative Care Program accepts referrals of very ill, pain-stricken individuals from
MTCT Plus, TB Control, PMTCT, and other programs.
The COPE Program trains all CBCHB health workers to consider all patients to be “clients”
who deserve respect, autonomy, and continuing improvement in quality of care.
Conclusion
The CBCHB ACP is a broad based, ongoing program, and we are open to all partners who are
interested in joining us in the fight against HIV and AIDS.
CONTACT:
CBC Director of Health Services
P.O. Box 1, Nkwen-Bamenda
NWP, Cameroon
Tel: (00237) 7776 47 81
Email [email protected]
OR
Regional Training Center, Mutengene
P.O. Box 152 Tiko SWP, Cameroon
Tel: (00237) 7750 40 70 / 7769 84 59
Email: [email protected]
Send tax-deductible donations to:
Flagstaff International Health and Education Fund Inc.
3243 Gila Drive
Flagstaff, AZ 86001
Phone 928-577-1636
E-mail [email protected]
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ANNEX A:
LIST OF PARTNERS
1. Ministry of Public Health (MOH) Cameroon: No financial support but gives a lot of
moral support and free ARVs and TB medicines.
2. Elizabeth Glaser Pediatric AIDS Foundation (EGPAF): Since 2000, has sponsored the
Call to Action implementation of PMTCT and supported the first program in Cameroon.
USAID and other foundations (Johnson & Johnson, Gates) have funded to EGPAF to
support the PMTCT Program in Cameroon. This funding enabled CBCHB to establish
and support PMTCT services in 352 facilities, including a $100,000 sub grant to
Lutheran Health Services to support PMTCT services in Adamoua Province.
3. Columbia University, New York, MTCT-PLUS. In 2004 supported family-centered care
and treatment in response to the needs of HIV positive women identified through the
PMTCT Program. Additional support provided by USAID in 2007.
4. Action for West Africa Region Grant: 2003 to 2008 for leadership development in HIV
and AIDS and Reproductive Health for the West and Central African Region of USAID.
5. Canadian Working Group on HIV and Rehabilitation (CWGHR). Recently the CWGHR
awarded a small grant to create awareness on the link between HIV and AIDS and
disability.
6. Hope for African Children Initiative Cameroon (HACI). Gave a one time grant of
$200,000 to help orphans and HIV positive mothers through microenterprize loans
administered by WINHEEDCAM.
7. Christofell Blinden Mission (CBM) Beinshem – Germany. Works with the CBC Health
Board on helping people with eye problems.
8. Bread for the World (BFtW) Stuttgart – Germany. Sponsors our primary health care in
40 villages and also sponsors community HIV and AIDS prevention.
9. CARE Cameroon, Implementation of home based care to HIV AND AIDS patients and
Orphans in the Southwest Province.
10. HEIFER Project International Cameroon (HPI). Supports VCT in selected villages.
11. UNICEF has sponsored the CBCHB to replicate COPE and to form support groups in
all the districts where UNICEF functions in Cameroon.
12. Hospice Africa, UK helped us start the first Palliative Care Program in Cameroon.
13. Centers for Disease Control and Prevention (CDC), Atlanta has been our partner since
2001, performing PCR testing at no charge and research related testing such as the
HIV Variant Study. CDC leases space at the CBCHB Health Services Complex in
Mutengene for its offices and laboratories.
14. The North American Baptist Conference and Baptist General Conference support the
Chosen Children Program.
15. The Flagstaff Fund International Fund for Health and Education: Supports various
CBCHB projects according to the wishes of the donors.
16. KWIHEED, a US based non-profit, funds microenterprize loans through
WINHEEDCAM (Women’s Initiative for Health, Education and Economic
Development) in Cameroon.
17. Global Strategies, US NGO, supported Adopt a Health Care Worker and HIV testing of
adolescents in the Youth Network for Abstinence.
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