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.
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.
Ariel Adherence Clubs (AACs) have been implemented across 6 regions in Tanzania, at 105 facilities, since 2007 by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). AACs were designed to address the social and behavioral barriers to HIV treatment, retention, and adherence faced by children and adolescents. All participants in AACs are required to know their HIV status. As such, trained providers work with caregivers to facilitate disclosure of HIV status to children and adolescents. Psychosocial support groups for HIV-positive children and adolescents aged 5–19 are provided at AACs. Clubs are grounded in the belief that children and adolescents living with HIV (ALHIV) will achieve improved health outcomes when clinical services are complemented by high-quality social support and age-appropriate information about HIV infection, treatment, adherence, HIV status disclosure, positive living, and life skills needed for growing and aging into healthy, HIV-positive adults. The purposes of AACs are to improve participant antiretroviral treatment (ART) adherence and clinic retention, and provide psychosocial supports to adjust to living with HIV and transitioning into adulthood and adult HIV care.
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 Zvandiri program, run by Africaid, began in Zimbabwe in 2004 as a support group for adolescents living with HIV. Community Adolescent Treatment Supporters (CATS), HIV- positive people aged 18-24 years, work between health facilities and the homes of youth living with HIV (YLHIV) to increase uptake of testing, linkage, and retention in care, adherence, and services related to sexual and reproductive and mental health. Monthly community-based support groups, community outreach teams, and clinic-based Zvandiri Centers provide safe spaces for accessing clinical and social services and linking adolescents to other forms of assistance, while educating individuals on sexual and reproductive health (SRH) and life skills. Through these interventions, the Zvandiri program builds mental, emotional, and physical resilience.