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Monday, 12 June 2017 21:13

Innovative models of care

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It has long been recognised that new models of HIV care are essential if we are to reach the 90-90-90 treatment targets. In a preconference session to the 8th SA AIDS Conference, FHI360 presented their experience of differentiated models of care in Nigeria and six countries in eastern and southern Africa. Innovations include a range of strategies across the 90-90-90 cascade, such as multi-month scripting, spaced clinic visits, decentralised care, ART clubs and ART refills in community, targeted services for adolescents and key populations, task shifting and many others.

Common features of the models are that they are based on a comprehensive understanding of the needs of stakeholders (particularly clients) and the context - including the policy environment, service delivery challenges, human resource availability and supply chain issues.

In all country programmes these models have been successful in increasing numbers of people testing, being enrolled into ART and retained in care.

Some fascinating insights come from countries that have implemented same-day initiation onto ART (or test-and-start), which has been shown to improve the linkages between testing and initiation onto ART. However, test-and-start has also has unexpectedly resulted in many people getting lost in the first month of treatment. FHI has found the suddenness of the process meant that clients were unprepared for a lifetime of drug therapy, and it was common for them to drop out very soon. To overcome this, FHI in Nigeria has piloted a first-month adherence support programme, which has increased retention from 58% to 97%.

Sexual network testing is a more controversial strategy piloted in Kenya to increase the yield from HIV testing. This involves a very careful process of counselling, partner notification and testing, which, in the Zimbabwe pilot, has doubled the number of new positive tests.

 

Common features of the models are that they are based on a comprehensive understanding of the needs of stakeholders (particularly clients) and the context - including the policy environment, service delivery challenges, human resource availability and supply chain issues.

In all country programmes these models have been successful in increasing numbers of people testing, being enrolled into ART and retained in care.

Some fascinating insights come from countries that have implemented same-day initiation onto ART (or test-and-start), which has been shown to improve the linkages between testing and initiation onto ART. However, test-and-start has also has unexpectedly resulted in many people getting lost in the first month of treatment. FHI has found the suddenness of the process meant that clients were unprepared for a lifetime of drug therapy, and it was common for them to drop out very soon. To overcome this, FHI in Nigeria has piloted a first-month adherence support programme, which has increased retention from 58% to 97%.

Sexual network testing is a more controversial strategy piloted in Kenya to increase the yield from HIV testing. This involves a very careful process of counselling, partner notification and testing, which, in the Zimbabwe pilot, has doubled the number of new positive tests.

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