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    Jan 17, 2021
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    Delivering HIV Care in Challenging Operating Environments: The MSF Experience Towards Differentiated Models of Care for Settings with Multiple Basic Health Care Needs

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    Name:
    Ssonko C et al - 2017 - Delivering ...
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    Authors
    Ssonko, C
    Gonzalez, L
    Mesic, A
    da Fonseca, M
    Achar, J
    Safar, N
    Martin, B
    Wong, S
    Casas, E
    Issue Date
    2017-07-21
    Submitted date
    2017-08-03
    
    Metadata
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    Journal
    Journal of the International AIDS Society
    Abstract
    Introduction: Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). Methods: A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Results: Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076–16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12–255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and peer support activities. Conclusions: The principles of differentiated HIV care for high-quality ART delivery can successfully be applied in challenging operating environments. However, success heavily depends on specific adaptations to each setting.
    Publisher
    International AIDS Society
    URI
    http://hdl.handle.net/10144/618976
    DOI
    10.7448/IAS.20.5.21654
    Additional Links
    http://www.jiasociety.org/index.php/jias/article/view/21654
    Language
    en
    ISSN
    1758-2652
    ae974a485f413a2113503eed53cd6c53
    10.7448/IAS.20.5.21654
    Scopus Count
    Collections
    HIV/AIDS

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