Angola’s Singing Nurses

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By Samson Ngonyani

An innovative lesson in treating HIV–positive pregnant women

Nurse-trainer Helena Cumbelembe Inacio was struggling to teach nurses at her health center the correct combination of medicines to prevent pregnant women with HIV from passing the infection to their children. The nurses couldn’t quite master the medication protocol. “The learning is slow, and they could not pronounce well the names of the [antiretroviral] drugs, let alone to remember the combination of the drugs,” Cumbelembe Inacio recalled.

Helena Cumbelembe Inacio, center, used a simple tune to help nurses remember HIV medication protocols.

Helena Cumbelembe Inacio, center, used a simple tune to help nurses remember HIV medication protocols.

Angola’s Institute for the Fight against AIDS had taken the bold step of accelerating a plan to expand Option B+, an approach recommended by the World Health Organization to offer all pregnant and breastfeeding women who are HIV-positive a combination regimen of three antiretrovirals immediately upon diagnosis that they would continue to take for life.

The nurses at the facility in Chorinde, a four-hour ride from the central city of Huambo, had the essential skills to care for patients but had not had refresher training in many years, and this new area of HIV treatment proved to be daunting. “I said, well, maybe through a song they will learn the names and the combination.” So, Cumbelembe Inacio and fellow trainer Dinis Cardoso reworked the lyrics of the French nursery rhyme Frère Jacques to follow the three-drug treatment regimen:

“TDF, TDF, 3TC, 3TC, Efavirenz, Efavirenz, all combined, all combined!”

Esquema preferencial: Te-De-Efe, Te-De-Efe, Tres t- ce, Tres t- ce, Efavirense, Efavirense, mistura, mistura

[Translation: Preferred regimen: TDF (Tenofovir), 3TC (Lamivudine), Efavirenz combined]

“The nurses sang and danced, the names stuck, and they could remember the combination very well,” recalled Cumbelembe Inacio. “Even when we went back for supervision they recited the [regimen] correctly.”

Jhpiego, in coordination with the Ministry of Health, has been working through the Strengthening Angolan Systems of Health (SASH) project to build the capacity of nurses to provide malaria treatment, family planning services, HIV testing and counseling, and now lifelong antiretroviral therapy (ART). SASH, known as ForçaSaúde in Portuguese, is funded by the President’s Emergency Plan for AIDS Relief through the U.S. Agency for International Development and is implemented with the partner Management Sciences for Health.

Through SASH, Jhpiego has trained more than 650 nurses in rural health centers in new skills that will better serve the needs of Angolan women and families. The benefit can be seen in the number of HIV-positive pregnant women who received ART in 2014. For example, of the 524 pregnant women diagnosed with HIV in Huambo Province, 343 or 66 percent received ART, an increase from only 13 percent in 2013.

That’s the kind of outcome that is saving lives and giving the next generation of Angolans a healthy start in life.

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