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