Tuberculosis is the leading cause of morbidity and mortality among people living with HIV; yet uncoordinated clinical care imposes heavy burdens on co-infected patients. In Eswatini, task shifting and the decentralization of TB and HIV treatment services to primary health centers allowed for TB/HIV integrated service delivery, or a ‘one stop shop’. These health system changes resulted in a 28 percent increase in ART initiation of co-infected patients between 2012 and 2017 and in a cohort study, almost 90 percent of TB and HIV co-infected individuals initiated ART within eight weeks per national guidelines. Overall, since implementation began, both morbidity and mortality related to TB have decreased significantly.
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.
In Kenya, adolescents and young people living with HIV (AYPLHIV) account for approximately 20% (303,700) of all people living with HIV (Spectrum Estimates, 2015; Kenya HIV Estimates 2015 Report). AYPLHIV (aged 10-24 years) face especially complex challenges dealing with a chronic illness amidst the physical, emotional and psychological developmental changes of transitioning from childhood to adulthood. The Operation Triple Zero (OTZ) initiative engages AYPLHIV as active stakeholders and partners in their health by promoting a responsive service delivery model.
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.