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.
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.
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 the Democratic Republic of the Congo (DRC), overall retention rates at the end of fiscal year 2016 (FY16/COP15) were documented to be 69.5%. As the country began transitioning to a Treat All model, many facility staff members were concerned they would be able to keep up with demand, given the ongoing long wait times for stable patients seen monthly in clinics. The Postes de Distribution Communautaire (PODI) plus model is a community-based, individual drug distribution and psychosocial support model. PODIs reduce the workload of overburdened health care workers by decreasing the number of patients individually attending the clinic, whilst maintaining good health outcomes for patients.
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.