HIV

Context

CAR is one of the countries in Central and West Africa with the highest HIV prevalence. In CAR, it is particularly difficult to benefit from good coverage of early antiretroviral treatment and lifelong HIV care. The chronic lack of reliable and conclusive information prevents the implementation of appropriate strategies to improve the care of people living with HIV. In addition, the reasons for engagement - disengagement in care have never been explored in the sites supported by MSF in CAR, where interventions to improve care can only be implemented if the specificities of the context are understood.

Main objectives 

Retrospective component

• To retrospectively describe the main follow-up indicators and the immune-virological outcome of patients included in the MSF-supported Carnot HIV cohort since 2011.

Cross-sectional component

• Estimate the prevalence of virological failures (CV ≥1,000 copies/ml) at 1st and 2nd line among a sample of patients (children and adults) on treatment for at least six months in Carnot district hospital.

Qualitative component (C)

• Describe the factors associated with engagement and disengagement with MSF-supported HIV services in Carnot from the perspective of PLHIV and the health workers responsible for their care.

Country

CAR

Status

Completed, currently being disseminated 

Tentative end date

December 2023

Our role

Coordination

Partners

MSF, MoH, Institut Pasteur de Bangui, KEMRI

Treatment failure is more frequent in adolescents living with HIV than in adults cohorts. In addition, while mortality has declined significantly among children and adults over the past 15 years, it has continued to rise among adolescents until 2015 and has been slowly declining since then.

The reasons for this specificity are multiple: disclosure poorly made or made too late, a long therapeutic history that led to the selection of resistance mutations, the lack of specific management of adolescents by poorly trained teams, etc.

In recent years, MSF France has developed programs in three East African countries with a focus on improving the quality of care for adolescents (10-19 years) living with HIV and on ART. Three different approaches have been developed: in Uganda, MSF supports Arua regional reference hospital’s AERT clinic; in Kenya and Malawi, interventions have been developed in rural districts, mainly at the health center level, but with a different approach. In Chiradzulu, MSF teams directly take care of the patients, while in Kenya's Ndiwa district, teams work in mentoring the Ministry of Health teams.

After about three years of adolescent-centered interventions, quantitative results show an improvement in indicators. It therefore makes it interesting to capitalize on these interventions in order to analyze the strengths and weaknesses of each approach, in order to guide other programs concerned with the problem of HIV-infected adolescents in other contexts.

The purpose of the analysis is to

1. Provide a description of the differentiated service delivery models (DSD) model implemented in the 3 HIV programs supported by MSF (Malawi-Chiradzulu, Kenya-Ndhiwa and Uganda-Arua) and the achieved coverage of the different services offered under the DSD model and

2. Determine the effectiveness of the models-of-care in improving treatment outcomes of adolescents aged 10 to 19 years living with HIV and enrolled in the 3 programs.

Country

Kenya, Malawi, Ouganda

Our Role

Quantitative Analysis of the achieved service coverage and the effectiveness of the model-of-care.

Who's Involved

OCP, Rider

An HIV population sero-prevalence survey conducted in 2016 by Epicentre in fishing communities surrounding Lake George and Lake Edward, in western Uganda showed a high awareness of HIV and Anti-retroviral Treatment (ART) initiation, at 86% and 78% respectively. However, viral suppression rate was at 67% among HIV-infected individuals on ART. It has been suggested that the mobile nature of the fishermen and limited access to ART sites are two major barriers to achieve viral suppression.

The main objective of the study is to evaluate the acceptability and describe outcomes (Viral Load suppression and retention) of two different ART delivery strategies for the target populations in MSF Landing sites, to reorient project activities and document best practices.

MSF replaced the former routine clinical follow-up at health center independently of individual HIV characteristics and implemented part of the MOH DSDM (Differentiated Services Delivery Models):

• the Fast Track Refill at Health Center level where stable clients pick their drugs from the pharmacy without going through the normal clinic flow, including a doctor’s review.
• the CCLAD at community level: the delivery of ART drugs at community level to a community ART group by one of the community ART group members on a rotational basis.

The purpose is to assess the MSF activities and patients’ outcomes in the landing sites in order to document best practices and generate recommendations for readjustment of MSF activities.

Country

Uganda

Tentative End date

December 2021

Our Role

Coordination

Who's Involved

OCP