Improving Patient Antiretroviral Therapy Retention through Community Adherence Groups in Zambia

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. Read More 

Reducing Dependence on External Donor Financing: Building Capacity for Social Health Insurance in Vietnam and Thailand for People Living with HIV

In many PEPFAR countries, most funding for a national HIV program comes from the host country. Nevertheless, programs for pecific communities and key populations (KP) remain largely dependent on external donor financing through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund). Local public resources to support the KP response have remained underused due to a shortage of social contracting systems, limited social health insurance capacity, and undefined policy frameworks. Read More

Increasing Access and Coverage of HIV-1 Early Infant Diagnosis through Use of Point of Care Testing in Mozambique

Mozambique has demonstrated the feasibility and impact of the use of point of care testing (POCT) for early infant diagnosis (EID), resulting in significantly reduced turnaround times and increased rates of antiretroviral therapy (ART) initiation. Strong partnership between the Ministry of Health (MoH) and other stakeholders was key to successful implementation. The success in Mozambique has been replicated in seven additional countries with partial data analysis showing the cost-effectiveness of initiation of infected infants on ART. Read More

In Malawi, men living with HIV (MLHIV) are less likely than their female counterparts to be aware of their HIV status, to be on antiretroviral treatment (ART) and to be virally suppressed. As a result, men are more likely to die of HIV-related causes. Some of the barriers experienced by men relate to access to HIV services, which are typically provided during working hours in congested facilities, and insufficient information about the importance of knowing your status and initiating ART early. Additionally, men may have perceptions of stigma when accessing HIV testing services through maternal and child health service (MCH) platforms. Read More

Uganda has made significant progress towards epidemic control through the scale-up of critical strategies including Test and Treat, differentiated service delivery models, the roll-out of the consolidated HIV guidelines, and ART optimization. However, the country still faces several challenges, including fidelity to implement the national strategies at scale. In January 2019, the AIDS Control Program (ACP) prioritized four areas for improvement: 1) improve viral load suppression (VLS) through the management of non-suppressed patients, 2) improve management of non-suppressed pregnant and lactating mothers, 3) improve early retention of people newly initiated on ART, and 4) improve Isoniazid Preventive Therapy (IPT) initiation and completion. Read More

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. Read More

Antiretroviral drugs (ARVs) are usually delivered at facilities, and distribution is frequently associated with long waiting times for patients. Additionally, where multi-month scripting or other differentiated-care models have not been implemented, clinic congestion impacts patients and providers, and is a barrier to patient adherence and retention. Read More

Online marketing is now increasingly leveraged to create demand for health services among an ever-growing population who has mobile phone, internet, and social media access. However, few solutions allow clients to seamlessly transfer from online engagement to offline service uptake. Therefore, the monitoring of online marketing efforts by health programs suffered. Furthermore, COVID-19 physical distancing and lockdown measures made it difficult for a member of the public to easily find and access health services and remain engaged in care. Read More

The rapid scale-up of antiretroviral therapy (ART) and viral load (VL) monitoring in Kenya has led to increasing numbers of people living with HIV (PLHIV) receiving both life-saving treatment and improved knowledge of viral suppression. This, in turn, contributes to Kenya achieving The Joint United Nations Programme on HIV and AIDS (UNAIDS) global epidemic control goal of 73% of all PLHIV being virally suppressed. One barrier to realizing this goal, is poor or limited responses when responding to PLHIV with viremia. Viremia is generally defined as the presence of viruses in the bloodstream. An HIV-positive person is considered to have viremia when they have greater than or equal to 1,000 copies of HIV per 1 milliliter of blood in their body (≥ 1,000 copies/mL). Challenges in providing rapid and comprehensive care to patients with high VL has led to poor optimization of ART adherence, delayed repeat VL testing, and delayed switch to 2nd-line ART. Read More

Many HIV-infected people do not enroll early in HIV care after their diagnosis, particularly if they are diagnosed in community settings. It is critical to identify effective linkage to care strategies for achieving control of the HIV/AIDS epidemic, especially for people diagnosed in community-based settings . This need is particularly great for country programs  with significant difficulty reaching men and linking them to treatment. Read More

Many HIV-infected persons do not enroll directly into HIV care and treatment following diagnosis, particularly among those diagnosed in community settings. The need to identify effective linkage-to-care and treatment strategies, especially for persons diagnosed in community-based settings is paramount towards achieving the 95-95-95 targets (that is, 95% of all people living with HIV know their status, 95% of all people with diagnoses HIV infection receive sustained antiviral therapy, and 95% of all people receiving antiretroviral therapy are virally suppressed). The need is particularly acute in countries that have a significant gap in reaching and linking men. Read More

Leveraging input from community leaders, “My Future. My Choice.” takes a multimedia approach to key population (KP) outreach, integrating social media engagement, television, and a new application to schedule HIV testing and services. The project has successfully reached new audiences and contributed to an increased identification of people living with HIV (PLHIV) among KPs who were previously hard to reach. Read More

International donor support, which accounted for three-fourths of Vietnam’s HIV prevention and treatment efforts, has drastically decreased in size and scope, causing stakeholder concerns about the sustainability of the HIV response in Vietnam. The majority of Vietnam’s 250,000 PLHIV and new infections are among key populations (KPs). Countries where the HIV epidemic is concentrated among KPs are disproportionately affected by decreases in donor funding. Furthermore, stigma and discrimination of these populations inhibit access to all vital HIV services at public facilities, necessitating alternative options outside of the public sector. Recent data suggest that HIV infections are increasing among men who have sex with men (MSM) and transgender women (TGW), while prevention interventions only reach a limited proportion of this population. Read More

In September 2015, the World Health Organization (WHO) recommended, “…oral pre-exposure prophylaxis as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches.”  WHO defines substantial risk of HIV infection, in the absence of pre-exposure prophylaxis (PrEP), as an incidence of HIV infection that is >3%. Offering PrEP in regions with such incidence could potentially make it a cost-saving or cost-effective intervention. In Thailand, the estimated national HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) is 19% and 14%, respectively. As part of the efforts to scale-up HIV testing services (HTS) and prevention interventions, along with proactive referrals to antiretroviral treatment (ART), PrEP for HIV prevention was formally made available in late 2015. However, there were no data on the acceptability to guide targeting and roll-out. Since PrEP is a relatively new prevention intervention in PEPFAR countries, PEPFAR’s partners will need technical assistance to scale best practices with fidelity and to ensure that implementation addresses the diversity of target populations across varied settings. Read More

Stigma and discrimination have been established as key barriers to HIV prevention and negatively impact all stages of the treatment cascade for people living with HIV (PLHIV) (Katz et al., 2013; Martinez et al., 2012). As countries approach epidemic control and their 95-95-95 targets, and move into the maintenance phase, stigma-reduction becomes increasingly important. People who are the hardest to reach and retain for prevention and treatment services are often those most affected by stigma, which increases their vulnerability to HIV. Read More

Mozambique has demonstrated the feasibility and impact of the use of point of care testing (POCT) for early infant diagnosis (EID), resulting in significantly reduced turnaround times and increased rates of antiretroviral therapy (ART) initiation. Strong partnership between the Ministry of Health (MoH) and other stakeholders was key to successful implementation. The success in Mozambique has been replicated in seven additional countries with partial data analysis showing the cost-effectiveness of initiation of infected infants on ART. Read More

Retention in care and adherence to life-saving antiretroviral treatment among children and youth remains challenging in Tanzania. Programs and models of care should be developed that address the unique needs of these populations to improve clinical outcomes and ensure achievement of epidemic control. Read More

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) face especially complex challenges dealing with a chronic illness amidst the physical, emotional, and psychological development changes of transitioning from childhood to adulthood. The HIV epidemic among adolescents and young people (AYP) is characterized by relatively high HIV incidence and sub-optimal treatment outcomes, including a relatively high loss to follow-up, low adherence to treatment, and low viral suppression. Read More

The Kingdom of Eswatini has the highest HIV prevalence in the world, yet fewer than half of HIV-exposed infants are retained in care long enough to receive their final HIV status at 18–24 months. Mothers and infants receive care together at child welfare visits through 18-24 months postpartum/of age, but there are high rates of loss to follow-up (LTFU) of mother-baby pairs (MBP) after the six-week visit. This poor retention in care limits the impact of prevention of mother-to-child HIV transmission (PMTCT) services as well as linkage to antiretroviral treatment (ART) for HIV-positive infants and HIV care and treatment services for HIV-positive mothers. LTFU of MBP also prevents them from receiving critical maternal, newborn, and child health (MNCH) services, including immunizations, growth monitoring, and supplements for infants – and family planning, infant feeding counseling, and cervical cancer screening for mothers. Read More

Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with HIV (PLHIV). Early antiretroviral therapy (ART) is recommended for all persons with TB/HIV co-infection, with multiple trials demonstrating that it reduces mortality and loss-to-follow-up, particularly in persons with advanced HIV disease. Despite this evidence, only 84 percent of HIV-positive TB patients received ART worldwide in 2017 leaving important gaps in ensuring that 90 percent of PLHIV are initiated on ART (World Health Organization [WHO], Global Tuberculosis Report 2017). One limiting factor may be that TB and HIV clinics are often physically separate, and thus are run by different programs. Separate and uncoordinated clinical care imposes heavy burdens on co-infected patients, potentially compromising adherence, retention, and treatment outcomes. Read More

Since its inception in Tanzania in 2009, voluntary medical male circumcision (VMMC) services for HIV prevention supported by Jhpiego have reached more than 870,000 clients. Subnational units reaching 80 percent male circumcision coverage shift from a scale up phase (where services are focused on achieving high targets) to a sustainability phase (where the focus is on maintenance of the 80 percent circumcision coverage over time). During the scale-up phase, more than 90 percent of the clients are served through periodic outreach activities supported by aggressive demand creation. Typically lasting two to four weeks at a time, the outreach activities are implemented by mobile teams of health care providers and community health promoters distributed over multiple sites close to population hubs in places far from health facilities. The remaining 10 percent of clients are served in facilities providing routine health services. In the sustainability phase, the service model shifts to focus the bulk of service provision in health facilities instead of at outreach sites. It was expected that during the sustainability phase uptake at routine health facilities would increase. This, however, did not happen: uptake of VMMC at health facilities remained low. There was an urgent need to devise a new strategy to increase uptake at health facilities. Read More

Male circumcision (MC) confers a significant level of protection against heterosexual HIV acquisition among men. Since 2009, voluntary medical male circumcision (VMMC) has been a key HIV prevention intervention in Tanzania, which has a generalized HIV epidemic. With nationwide MC prevalence nearing 80 percent among males aged 15-29 years (Tanzania PHIA, conducted 2016–2017), the Government of Tanzania (GoT) appears to be on-track to reach its target of 90 percent of MC prevalence among 10-29 year-olds by 2020. In the past, VMMC program planning was often based on regional male population and MC prevalence estimates, missing significant geographic variability within regions and leading to inefficiencies in program planning and implementation. Prior to program implementation, local community members’ and health workers’ knowledge often was not sought. However, as coverage increases, the population of uncircumcised men shrinks and it becomes increasingly difficult to reach eligible uncircumcised men with VMMC. Thus, to inform targeted VMMC program planning and implementation require innovative approaches in order to reach the remaining uncircumcised men in Tanzania. Read More

 

U.S. Department of State

The Lessons of 1989: Freedom and Our Future