Philippines

Dr. Joseph R. Masci was an infectious disease specialist and public health leader who spent more than 40 years working to improve the lives of patients in New York City and around the world. He was also a highly valued AIHA partner who spearheaded multi-year twinning partnerships to improve HIV/AIDS care in Ethiopia and Russia.

Dr. Masci was known by all to be a caring, compassionate doctor, who educated and mentored infectious disease physicians who trained at Elmhurst Hospital Center and around the globe. He was a role model who combined vast knowledge with a kind, empathetic, patient-centered approach.

Through the Joseph R. Masci Legacy Project, AIHA is both humbled and grateful to be working with Dr. Masci’s family to design and implement capacity-building projects that honor his legacy as a physician, teacher, mentor, and public health leader. With support from his family, AIHA launched the Dr. Joseph R. Masci Legacy Project in September 2024, a new two-year endeavor to strengthen institutional and human resource capacity at two international hospitals – Debre Berhan Comprehensive Specialized Hospital in Ethiopia and Philippine General Hospital in Manilla, Philippines.

In the Philippines, AIHA worked with stakeholders at Philippine General Hospital, to identify the following development priorities:

1. Supporting the reconstruction of the resident-fellow training hall, which was destroyed by two devastating fires this past year
2. Providing scholarships to enable 10-15 residents to complete a mandatory specialty study abroad course
3. Providing technical assistance to strengthen the hospital’s pandemic and emergency preparedness
4. Establishing an HIV and infectious diseases mentorship program

To learn more, please click here to visit the project page.

In Southeast Asia, AIHA began project implementation in the Philippines in 2021. Starting in 2022, the Philippines has been the focus of AIHA’s activities under CDC1950. To read a more detailed description of project accomplishments to date, click here.

Building the capacity of Filipino civil society organizations (CSOs) – particularly those led by and serving key populations (KPs) that are driving the country’s HIV epidemic – and employing evidence-based techniques to enhance targeted case finding such as community-based index testing, self-testing, and social network strategies with linkage to treatment are chief priorities for the project. AIHA is also working with KP and CSO-led organizations and other stakeholders to combat stigma and discrimination, as well as helping to enhance the technical and organizational skills of CSOs and KP groups so they are more effective at their work.

Our work is focused in two of the most challenging regions of the Philippines: Region 6 (Western Visayas) and Region 7 (Central Visayas).

In the first year of the project, AIHA focused our efforts on organizational capacity assessments (OCA) of relevant HIV/AIDS and KP-led CSOs in the Philippines, which resulted in the development and deployment of OCA-based training and mentorship programs for HIV and KP-led CSOs. 

In the second year of the project, AIHA reviewed existing systems with the goal of improving case finding at the community level, linking to care and initiation of treatment in Regions 6 and 7. To better understand current barriers and perspectives from community and KP points of view, AIHA organized a series of consultations facilitated by experts from the CDC in September 2022 focusing on topics such as social networks strategy (SNS), community engagement, and listening sessions with MSM groups in Iloilo and PWID and transgender women in Cebu.

In the third year of the project, in close collaboration with CDC and DOH, AIHA worked to enhance targeted case finding and KP competencies, ramp up a rapid HIV diagnostics algorithm, and create demand and scale up for PreP.

AIHA supports community-based index testing and self-testing with local CSOs in regions 6 and 7, peer navigation for linkage to care from CSO community-based testing sites, and community messaging for U=U and stigma reduction. AIHA identified 10 CSOs and KP-led or KP-competent CSOs from these regions to partner with on HIV case finding and linkage to care. We assessed the skills and competencies of Peer Navigators and Community-based Screening Motivators from our collaborating CSOs listed below to determine the gaps and develop targeted training and mentorship interventions.

Region 6 (Western Visayas):

• FPOP Iloilo (Iloilo City)
• Capiz Shells (Roxas City)
• Aklan Butterfly Brigade (Kalibo, Aklan)
• Antique Red Sea Horse (Antique)
• Boracay Red Lace (Boracay Island)
• Kabankalan (Kabankalan City)
• Cadiz (Cadiz City)

Region 7 (Central Visayas):

• LoveYourself Whitehouse
• IDUCARE
• CURLS

All activities implemented by AIHA and our partners in both regions are coordinated with and supported by the Department of Health and Provincial Health Offices.

Meeting with DOH team (AIHA, LoveYouself, CDC)

Meeting with the Provincial Health Office and CSO Capiz Shells in Roxas City, Region 6

Outreach activities at the community level are provided by all 10 CSOs and include brief HIV101 training, Questions and Answers sessions and HIV testing.

Pictures below are from one of the community outreach activities conducted by the IDUCARE in Region 7.

Outreach activities in Region 6 conducted by Capiz Shells in Roxas City:

Implementation Highlights:

HIV testing is an essential gateway to HIV prevention, treatment, care and support services, in order to reach 95-95-95 targets among All People Living with HIV in PEPFAR-Supported countries by 2025. However, traditional HIV testing may not be enough to reach this goal. Social network testing is a strategic case finding method that has been proven to increase HIV testing yield. The CDC team recently conducted a set of trainings aimed at increasing the capacity of CSOs to fully execute and manage the social network strategy (SNS) to increase HIV case identification and linkage to PrEP, HIV treatment and care among key populations and those at elevated risk for HIV. This training equipped healthcare workers and CSOs to implement social network testing with fidelity to maximize limited resources and identify new cases of HIV infection. AIHA launched SNS in April 2023 in both regions.

In March 2023, AIHA conducted a survey at several project sites to understand key priority issues for the KPs in terms of safety and security, stigma and discrimination, community engagement and the quality of services. A total of 50 respondents answered the survey. 41 of them are members of KP and are PLHIV, while the remaining are clients who are accessing the facility for other HIV related services (testing, and PrEP).

About 46% of KPs and clients cited having experienced safety and security incidents because of their HIV-status. This included sexual assault (including rape) and verbal abuse and intimidation, both on-line and at their home. Furthermore, KPs and clients reported that this discourages them from seeking HIV related services (testing, treatment, counseling, etc.). That in turn will increase the risk for HIV infection, and, for some, long term complications associated with HIV such as opportunistic infections and the development of deleterious mental health problems (e.g., anxiety).

In response, KPs and clients recommended steps on how to better address safety and security issues such as: advocating to decision makers about the impact of safety and security challenges and the changes needed; sensitizing key stakeholders; providing legal assistance; establishing a system (i.e. databases) to document safety and security incidents and trauma; and counseling/psychiatric debriefing.

At least 74% of the KPs reported having experienced HIV-related stigma. Most commonly cited was people becoming fearful of them (because of their HIV status) and persistent anxiety that people will be gossiping about their HIV status. On the other hand, the prevalence of HIV-related discrimination is lower (32%) among KPs. Most common forms of discrimination experienced by KPs were: people avoided physical contact with them; being refused admission to a healthcare facility/school; and being deprived employment opportunities.

They shared recommendations on how HIV-related stigma and discrimination can be reduced, including: talking openly about HIV to normalize the subject; providing HIV-related legal services; legal literacy (“know your rights”); educating/sensitizing law makers and law enforcement officials; and strengthening the ongoing media campaign against HIV-related stigma and discrimination.

85% of KPs and clients still believe that the creation of a Community Advisory Board (CAB) will be instrumental in putting forward the needs of people affected by HIV/AIDS.

Ultimately, KPs and clients were asked for their suggestions on how they think the delivery of HIV-related services can be improved. They provided recommendations that will be shared with stakeholders and implemented.

In 2023, AIHA, in collaboration with its partners, will focus on delivering Community Based Screening and Testing with the goal to help HIV- positive to know their status, initiate treatment and improve quality of life, and reduce stigma and discrimination.

USAID’s HRH2030 program began partnering with the Philippines Department of Health in 2018 to strengthen the deployment, training, and management of the health workforce to improve access to and quality of tuberculosis, family planning, and maternal and child health services in the Philippines. Key objectives were to:

• Improve the skill mix, competency, and distribution of the health workforce at the primary level
• Strengthen human resources for health leadership, governance, and performance management
• Advance the use of data for human resources for health decision-making at central and regional levels

In keeping with these objectives, AIHA developed The Health Academy available via e-Learning portal for the Department of Health in the Philippines.. USAID considers the portal we developed and training we provided as one of best practices for utilization of e-Learning on a national level for user-friendly continuous professional education courses to strengthen the knowledge and skills of the country’s health workforce, specifically physicians, nurses, midwives, and medical technologists. Targeted learning focus areas were tuberculosis, family planning, and maternal and child health.

AIHA designed the platform and materials to be a publicly available resource for more than 100,000 people. The DOH e-Learning Academy is delivered on the Moodle open-source platform. Content for one-hour content modules continue to be prepared by local experts. This ensures all training is of high quality, evidence-based and consistent with local procedures. AIHA tested and disseminated these modules in mobile smart phones, laptops, tablets, or desktop devices. The modules are accessible for instruction completely off-line by downloading with Wi-Fi onto any device. The offline version can be delivered in small groups of trainees in face-to-face training or can be completed by an individual.

Since its launch in October 2019, the e-learning portal now serves as a platform for additional coursework, including courses developed in 2020 to address COVID-19 related issues. 4 out of the 18 DOH Academy courses were developed with HRH2030, running from October 2019-January 2021, with more than 5,000 participants in a single course since its launch.

To learn more about this project, including project accomplishments, please read: 

• Three Questions with Roxanne Zaghab: Innovating for Improved Health Worker Training
• Elated About e-Learning: A Critical Tool for Advancing UHC
• Introducing Online Training for Health Workers in the Philippines