Last week the 21st International Aids Conference (Aids 2016) took place in Durban, South Africa. Yours truly was not there, but my surf of the internet and of some of the papers that were presented revealed that ‘interventions which reduce the need for people to attend clinics are proving highly successful in retaining people in care and supporting adherence to HIV medication in southern Africa.’
The new wave of interventions— described as ‘differentiated care’ in guidelines – are intended to reduce clinic visits, waiting times and monitoring requirements.
This is a huge benefit for patients as there is less time spent waiting in clinics and travelling to clinics, fewer out-of-pocket travel expenses and less time off work due to clinic attendance, and more support in the community for adherence to medication.
While the advantages for health services come in the form of increased capacity to deal with growing patient numbers, more time to concentrate on patients with complex needs, and better retention of patients in care due to the use of community health workers and other community-level mechanisms for supporting treatment.
An example of differentiated care presented at the conference was six monthly appointments. A review of a switch to six-monthly appointments for clinically stable patients in Malawi found that the switch to six-monthly appointments reduced attrition from HIV care and saved 30000 clinician consultations in one district in 2014 alone. MSF switched from monthly or three-monthly appointments to six-monthly appointments for clinically stable patients in its treatment programme in Chiradzulu district as far back as 2008. Patients obtained drug refills from the pharmacy every three months.
Another example was Community ART refills in Swaziland, where patients were given the option of moving to various types of community care, all of which offered a reduced amount of clinic attendance. These options included facility-based adherence clubs (three-monthly) where around 30 patients attend to pick up pre-packaged medication. Blood draws for viral load and clinical symptom reporting formed part of each session. Community ART groups of around six patients, self-formed by patients, at rural facilities, in which members take turns to collect medication and attend the clinic; group sessions the following day involve medication pick-up, pill counts, adherence support and checking weight. Outreach service for very remote areas, where pre-packaged medication is delivered monthly.
These initiatives are line with new guidance from World Health Organisation for national treatment programmes to begin thinking in terms of delivering treatment to four different groups of patients—people presenting well, people with advanced diseases, stable patients and unstable patients.—www.Aidsmap.com.