7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


TUAD01 Two Sides of the Same Coin: Demand Creation and Supply Strategies for HIV Services
  Oral Abstract Session : Track D Operations and Implementation Research
Venue: Session Room 1
Time: 02.07.2013, 16:30 - 18:00
Co-Chairs: Maznah Dahlui, Malaysia
Nancy Padian, United States

16:30
TUAD0101
Abstract
Powerpoint
Community anti retroviral therapy (ART) delivery models for high patient's retention and sustaining good adherence: the AIDS Support Organisation (TASO) operational research findings, CDC/PEPFAR funded project in Uganda
D. Mpiima1,2,3, J. Birungi1,4, C. Luzze5,6, S. Kanters7, R. Makabayi8,9
1The AIDS Support Organisation, Medical, Kampala, Uganda, 2International Health Sciences University, Public Health, Kampala, Uganda, 3Uganda Society of Health Scientists, Kampala, Uganda, 4Manchester University, Public Health, Manchester, United Kingdom, 5The AIDS Support Organisation, Programme Management and Strategic Information, Kampala, Uganda, 6Makerere University, Information Techinology, Kampala, Uganda, 7University of British Columbia Center of Excellency, Vancouver, Canada, 8The AIDS Support Organisation, Research, Kampala, Uganda, 9Makerere University, Public Health, Kampala, Uganda

16:45
TUAD0102
Abstract
Powerpoint
Webcast
Decentralization of HIV care and treatment services in Central Province, Kenya: adult patient characteristics and outcomes
W. Reidy, M. Hawken, C. Wang, E. Koech, B. Elul, E. Abrams, Identifying Optimal Models of HIV Care in Africa: Kenya Consortium
ICAP at Columbia University, New York, United States

17:00
TUAD0103
Abstract
Outcomes of national expansion program for antiretroviral treatment to rural health centre level through mobile HIV services in Zambia
A. Mwango1, I. Sikazwe1, K. Komada2,3, S. Miyano2,3, G. Syakantu4
1Ministry of Health, Clinical Care and Diagnostic Services, National ARV Program, Lusaka, Zambia, 2Project for Scaling up of Quality HIV/AIDS Care Service Management, JICA, Lusaka, Zambia, 3National Center for Global Health and Medicine, Bureau of International Medical Cooperation, Tokyo, Japan, 4Ministry of Health, Clinical Care and Diagnostic Services, Lusaka, Zambia

17:15
TUAD0104
Abstract
Powerpoint
Webcast
Evaluating the effects of three HIV counseling and testing strategies on male most-at-risk-population
S.B. Adebajo, J. Njab, G.I. Eluwa, A. Oginni, F. Ukwuije, B. Ahonsi
Population Council, HIV/AIDS, Utako, Nigeria

17:30
TUAD0105
Abstract
Powerpoint
Webcast
Use of referral vouchers to measure increased demand of HIV counseling and testing among key populations in Kyrgyzstan
S. Aufenkamp1, I. Shayakhmetov2, L. Koushenova1, M. Bakpayev1, J. Gall1, M. Kan1, D. Alisheva3
1Population Services International, Almaty, Kazakhstan, 2Bishkek City AIDS Center, Bishkek, Kyrgyzstan, 3Population Services International (PSI), Bishkek, Kyrgyzstan

17:45
TUAD0106
Webcast
Moderated discussion

Powerpoints presentations
Community ART delivery models for high patient's retention and sustaining good adherence: the AIDS Support Organisation (TASO) operational research findings, CDC/PEPFAR funded project in Uganda - Denis Mpiima

Decentralization of HIV care and treatment services in Central Province, Kenya: adult patient characteristics and outcomes - William Reidy

Evaluating the effects of three HIV counseling and testing strategies on male most-at-risk-population - Sylvia Bolanle Adebajo

Use of referral vouchers to measure increased demand of HIV counseling and testing among key populations in Kyrgyzstan - Djamila Alisheva



Rapporteur report

Track D report by Thomas Odeny


This session focused largely on interventions aimed at increasing uptake of HIV prevention and care services, and reducing losses to follow-up from ART care. Two studies were specifically focused on improving uptake of HIV counseling and testing among key populations.

Denis Mpiima from The AIDS Support Organization (TASO) in Uganda presented on community ART delivery models targeted at improving patient retention and medication adherence.TASO is a large CDC/PEPFAR-funded HIV care organization in Uganda with over 90000 patients active in care. TASO designed a strategy known as Community Drug Distribution Points (CDDP) and evaluated the effect of this strategy on retention in care and adherence to treatment. CDDPs are public places selected by clients to access ART refills. Patients chose a CDDP of their preference after counseling and health talks. TASO evaluated retention (alive and in care) and adherence to treatment (>95% as measured by self-report) at CDDPs versus health facilities. The proportion of patients lost to follow-up was significantly higher at health facilities (16.5%) compared to CDDPs (4.3%). Adherence was higher in CDDPs (96.8%) than facilities (95.6%) although the difference was not statistically significant. He concluded by recommending that health facilities with high patient volumes should consider the CDDP model.


William Reidy from ICAP presented on decentralization of HIV care and treatment services in Central Province in Kenya. Following the government of Kenya's launch of decentralization of HIV care in 2006 from secondary health facilities to lower level primary health facilities, the ICAP group aimed at comparing patient outcomes at primary versus secondary health facilities in Central Kenya during the period of decentralization. Data were from 37/52 government supported facilities (15 secondary, 22 primary facilities). 26,690 participants were enrolled between 2006-2010. Data sources included electronic patient-level databases and annual facility surveys conducted by ICAP. Key outcomes were number of patients enrolled in HIV care by year, patient characteristics, and facility-level characteristics. Quality of care was assessed by looking at assessment of eligibility and promptness of ART. Retention was defined as alive and in care at the facility. Patient enrollment in HIV care increased in primary facilities over time as volumes at secondary facilities decreased, in concert with decentralization of HIV services. Patient characteristics were generally similar comparing primary and secondary health facilities. There were high levels of missing data at patient enrollment, with 40% of patients not having a CD4 record overall, and 11% and 24% missing WHO clinical staging at primary and secondary facilities respectively. Of note, 20% of enrolments at primary facilities were transfers in from another facility. Proportions of patients with ART eligibility assessed were similar at both types of facilities. Loss to follow-up among pre-ART was lower in the primary facilities (HR=0.77; p<0.05). There was no statistically significant difference in proportions of deaths and losses to follow-up when comparing patients initiated on ART at primary versus secondary facilities. In summary, patient enrolment at primary facilities increased dramatically during decentralization, and the quality of care and retention were comparable between primary and secondary facilities.

Following a question from a member of the audience, the presenter acknowledged that the estimate of lossess to follow-up is biased in that it does not account for patients attending care at other facilities who transfer out without informing the facility of origin. He also acknowledged that the estimate of mortality is biased to the extent that it does not include deaths among the lost to follow-up.

Albert Mwango from the Zambia Ministry of Health presented on the outcomes of a national expansion program for ART to rural health centers through mobile HIV services, with a focus on retention outcomes. In 2010, the Zambia MOH launched guidelines for national mobile HIV service. Ten districs piloted expansion of ART into rural health centers. In 2011, 5 more districts were added to the pilot. A retrospective data review was conducted at the 15 districts. Review included data on ART retention (alive and in care) at 12 and 24 months. Compared to the districts that did not have mobile ART sites, the number of rural health centers providing mobile ART services in the 15 districts improved from 46 to 110 three years after introduction. The number of active patients on ART in mobile sites in the 15 districts increased from about 3000 to more than 8000 three years later. Patient retention at 12 months was significantly higher at districts with mobile facilities (92.7%) than those with static sites (85.5%) (p<0.001). Retention at 24 months was significantly higher in the mobile ART sites. The presenter concluded that this alternative approach to service delivery may be an effective strategy to improve access to ART care in rural Zambia.

Sylvia Adebajo from the Population Council presented an evaluation of the effects of 3 HIV testing strategies on uptake of HIV testing and counseling (HTC) among male most-at-risk populations (MARPS) in Nigeria. The Population Council launched the Men's Health Network Nigeria (MHN) which provides clinic and community-based interventions to avert new infections among male MARPs. The MHN developed 3 different strategies to improve uptake of HTC: S1) static facility-based clinics with male MARP peer educators and key opinion leaders (KOL) referring their peers; S2) KOLs referring their peers to nearby mobile HCT teams; S3) KOLs mobilizing their peers and providing HTC. Structured questionnaires wre administered by conselors. Successful HTC was defined as the number tested, counseled and receiving results. Segmented linear regression was used to analyze factors associated with HTC uptake. More than 30000 male MARPS received HTC. Majority of MARPS were employed and were first-time testers. Overall, S3 had the highest effect on the total number of MARPS, HIV-positive MARPS reached, and number of new testers reached. The presenter concluded that training MARPS peers to provide HTC (S3) may be a high impact intervention to deliver HTC to male MARPS.

Djamila Alisheva from PSI presented on the use of referral vouchers to measure increased demand of HIV counseling and testing among key populations in Kyrgyzstan. The project was part of the USAID Dialogue on HIV and TB, a project for improving health behavior among key populations. The referral voucher system used vouchers with two sections: 1) one kept by the outreach worker who provides referral; 2) another given to the referred individual and collected by the service provider when HTC is done. Three years after project launch, more than 17,000 individuals were reached, of whom about 4800 were referred for HTC. Among sex workers, HTC use after referral with the voucher increased from 17% to 19% over 3 years; among MSM, referrals increased from 7% to 54% three years later. Although no statistical analyses to compare the proportions were conducted, the presenter concluded that the increased uptake of HTC was evidence of the effectiveness of the referral voucher system.



   

    The organizers reserve the right to amend the programme.