As coverage of male circumcision increases, it becomes more difficult to identify eligible men for this HIV prevention activity. Using triangulated data to generate maps has helped to identify areas of eligible men and thus increased program performance by 200 percent. Through innovative solutions like this one, Tanzania is on-track to reach its target of 90 percent male circumcision coverage among 10-29 year-olds by 2020.
In Malawi, men living with HIV are less likely than their female counterparts to be aware of their HIV status, on antiretroviral treatment, and virally suppressed. To address barriers that prevent men from accessing HIV services, the Elizabeth Glazer Pediatric AIDS Foundation designed and opened male-friendly clinics to provide integrated HIV, reproductive health, and non-communicable disease services during times that are more suitable for men; in this case, on Saturdays from 7:30 am-2:00 pm. The resulting mean HIV positivity rate at male-friendly clinics is 5 percent, with yields as high as 15 percent among men aged 35 - 39. Men accessing male-friendly clinics reported being more comfortable in men’s clinics and that Saturdays were more convenient. This suggests acceptability of this service delivery model, which contributed to the improved health outcomes for men.
Voluntary medical male circumcision (VMMC) is an evidence-based prevention approach that can reduce HIV transmission. However, sustaining demand and lowering costs of this core intervention can be challenging. In Tanzania, engagement and use of a volunteer community-based cadre of lay workers to promote and create demand for VMMC led to an almost five-fold increase in VMMCs performed in health facilities. This increase was sustained over time, with a cumulative 45,182 VMMCs performed eighteen months after the introduction of this model. Moreover, this model also reduced costs by 13%.
Through the support of the United States Government’s President’s Emergency Plan for AIDS Relief (PEPFAR), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) introduced comprehensive men’s clinics at selected high-volume health facilities in order to scale-up the Test and Start approach among HIV-infected men. The men’s clinics provide a male-friendly environment that encourages men to get tested for HIV, and therefore be identified as HIV positive and linked to HIV care and treatment services.
The establishment of viremia clinics was an initiative to address the gaps and challenges in the monitoring and management of patients with high VL, and function as a form of differentiated care for unstable clients with high VL. Held at least one day a month, the viremia clinic utilizes a multidisciplinary team (MDT) model and focuses on enhanced case management and a patient-centered approach. This model is aimed at identifying patient-specific adherence barriers and tailoring interventions to address the patients’ specific needs. Patients are empowered to make joint decisions with their providers to improve their ART adherence.
Faced with challenges to patient adherence and retention on antiretroviral therapy (ART), Mozambique implemented a community approach to service delivery. This approach provides patients with easier access to their antiretroviral treatment, in addition to peer support.
Because the majority of antiretroviral therapy (ART) services provided in resource-limited settings are done so in standardized yet inefficient ways, long-term ART adherence and retention is difficult. In Uganda, stable clients needed ways to access medications closer to their homes, which would reduce the cost and disruption of remaining adherent to ART.
Antiretroviral therapy (ART) is frequently distributed via health facilities and their pharmacies. An increased volume of medically-stable patients at facilities reduces the time clinicians can spend with those who require acute care and also discourages patients from attaining care, due to long wait times. For medically-stable patients, going to a health facility for monthly refill pickup reduces the likelihood of retention on treatment for a variety of factors, including the transportation costs and financial losses of time missed at work incurred by a trip to the health facility . Importantly, retention on ART is vital to the health of HIV-positive individuals, but also to the well-being of the communities in which they live. Achieving higher rates of retention among HIV-positive patients, then, is crucial.
The Bukoba Combination Prevention Evaluation (BCPE) in Tanzania has an innovative, peer-delivered, linkage-case-management (LCM) program for people 18-49 years old who are diagnosed in community and clinical settings. Through LCM, HIV-positive patients receive a package of peer-delivered linkage services recommended by the International Association of Providers of AIDS Care (IAPAC), the U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO). The standard set of linkage-to-care recommendations helps ensure all people living with HIV (PLHIV) enroll in care in a timely manner.
The Western Cape Government Department of Health adopted the adherence club (AC) model for the Cape Metro district in January 2011. The ART-AC model provides patient-friendly access to ART for clinically stable patients, ART distribution, and care and support to groups of stable patients. ACs can reduce the burden that stable patients place on healthcare facilities, freeing healthcare workers to treat new and unstable patients.
Through community-based testing, HIV-infected clients are provided baseline clinical care and a comprehensive package of peer-delivered linkage services recommended by the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). CommLink mobile clinical and linkage services initiated at the point of HIV diagnosis are designed to help community clients “link” to a local facility for lifetime HIV, care, treatment, and support.