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Impact of DSD on Retention and Virological Suppression of Female Sex Workers living with HIV during COVID 19
10th December 2020
ABOUT US
•The International Centre for Reproductive Health Kenya is an
independent, local non-governmental organization (NGO).
• ICRH Kenya is affiliated to other ICRH offices in Mozambique and in
Belgium
• ICRHK work falls under four main thematic areas – HIV/AIDS,
RMNCH/FP, Sexual and Gender-Based Violence and Adolescents Sexual
Reproductive Health
INTRODUCTION
• There is precedent for expediting DSD approaches during times of
emergency. During the 2014‐2015 Ebola outbreak, Guinea started providing
PLHIV with 6‐month ART refills – both to ensure that patients were not
exposed to Ebola by visiting health facilities and because many health
facilities closed .This had a positive impact on retention of PLHIV clients
• Likewise In the wake of COVID-19 pandemic with the initial ban on
restriction and persistent containment measures in place that aimed to reduce
physical contact there persists a need to ensure uninterrupted ART provision
and retention of HIV clients is still present.
DSD MODELS(PRE COVID)
NASCOP recommended stable clients to be put on major DSD models in support of WHO 2016 recommendation
• Community ART Groups (CAGs).People living with HIV meet at the community and a service provider would lead these gatherings that served as PSSG,ART dispensing and VL sample collection points
• Facility ART Groups (FAGs):People living with HIV would meet as a group at the facility vs stand alone visits. This was important in reducing workload for the service provider. These groups served as venues for PSSG,ART dispensing and VL sample collection points
• Fast track model where the clients had three monthly encounters with the facility for refills during which there would be alternations in the clinical consultation
ADAPTATIONS OF DSD IN RESPONSE TO COVID 19Post COVID the models were adapted as follows:
1. All HIV positive clients both onsite and offsite irrespective of stability status were put on a DSD model as recommended by NASCOP
2. From March 2020 after the lockdown we started giving multi month dispensing in all models
Problem Statement
• Due to restriction during COVID 19 we fore saw a rise in
defaulter rates and fall in viral suppression of clients as a result
of the containment measures that limited access to the facility
and the context of current pressure on health systems posed by
the pandemic
Hypothesis
• We hypothesized that incorporation of all clients on DSD models
and provision of drugs at the community would see equal retention
and virological suppression of FSW living with HIV on ART
MAIN OBJECTIVE OF THE STUDY
This study aimed to evaluate the impact of differentiated service
delivery adaptations on retention and virological suppression of
the FSW living with HIV during COVID 19
METHODOLOGY
• Study was a time-series analysis of routine program data,
comparing HIV viral load suppression, retention rates among
FSW receiving services at ICRHK-supported clinics (drop-in
centers) on DSD before COVID-19 (1st October 2019 to 31st
March 2020) and during the COVID-19 period (1st April 2020
to 30th September)
DSD SEGGREGATION
PRE COVID POST COVID
ON DSD NOT ON DSD ON DSD NOT ON DSD
715 165 819 146
RETENTION CASCADE
629
1128
179
86
172
79
PRE COVID POST COVID
FEMALE SEX WORKERS RETENTION CASCADE
TOTAL ACTIVE TOTAL DEFAULTERS RETURNED TO CARE
SUPPRESSION CASCADE
629
1128
342
524
323
498
94%
97%
93%
93%
94%
94%
95%
95%
96%
96%
97%
97%
98%
0
200
400
600
800
1000
1200
PRE COVID POST COVID
TOTAL ACTIVE VIRAL LOAD DONE SUPPRESSED PERCENTAGE
CONCLUSION
From our findings we have seen:
• Increase in virological suppression from 94% to 97%
• There has been an increase in retention rates and the models have assisted in defaulter tracing
We disproved our hypothesis that stated “Due to restriction due to COVID 19 there would be a rise in
defaulter rates and fall in viral suppression of clients as a result of the containment measures that
limited access to the facility and the context of current pressure on health systems posed by the
pandemic”
We will continue to use these models in care of PLHIV as they have been result oriented and
sustainable and NASCOP recommends continuity