Clinical Insights, Risk Stratification, and Enhancing Outcomes.
Enhancing access to community clinical services
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Transcript of Enhancing access to community clinical services
Enhancing access to community clinical services
July 2014
LINKAGES - Overarching goal
Accelerate the ability of governments, KP organizations and private sector providers to collaboratively plan, deliver and optimize services that reduce HIV transmission among KP and extend life for those who are HIV-positive.
Implemented by core partners: FHI 360, IntraHealth, PACT and University of North Carolina (UNC)
Key focal areas
• Increased availability of comprehensive prevention, care and treatment services, increasing coverage across the Continuum of Care for key populations
• Demand for comprehensive prevention, care and treatment services among key populations enhanced and sustained
• Strengthened systems for planning, monitoring, evaluating and assuring the quality of programs for key populations
Strategic approach
Ultimately increasing…
• Access to better quality, more integrated HIV services closer to home in welcoming settings that protect their privacy
• Support from trained peers who can help them access HTC and other HIV services, as well as legal aid, psychosocial and nutrition support, and economic opportunities
• KP-friendly HCWs who understand and address their multi-faceted needs in a non-stigmatizing way
• Safer communities, with less gender-based and other violence and stronger crisis response systems
• Meaningful opportunities to have their voices heard in how services are delivered, improved and evaluated
• Relevant communication that empowers them to be savvy health care consumers and make decisions that lead to better health
• Protective environments and mitigating impact of discriminatory laws
The Cascade Framework
The Cascade framework is…
• Old, but new…building on the continuum of care• Improvement on older methods for presenting data &
illustrating program performance• Simple, easy to communicate with powerful impact• Easily adaptable to different programs, strategies and
populations • Promotes different interventions targeted to different
phases of - or gaps in - the cascade• Based on a set of available core indicators
The Cascade Framework: Patching a Leaky Pipe
The cascade
HIV cascade - MozambiqueSummary of flow in HIV Care system, Beira and Chimoio, July 2004 - June 2005
0
1000
2000
3000
4000
5000
6000
7000
8000
Step 2 Step 3 Step 4 Step 5
HIV+
Enroll ART clinic <30d(56%)
CD4 testing <30d(77%)
Eligible for ART(49%)
Started ART <90d(31%) On ART >180d
(81%)
Adherence >90% at 180d(83%)
Step 2:Drop-off 44%
3,049 lost
Step 4:Drop-off 69%
1,035 lost
Micek et al 2008
Cascade of HIV diagnosis, care and treatment in Vietnam among key populations, Sep-2013
Estimated PLHIV
Diagnosed PLHIV
Enroll in care
Sustain on ART
0
50000
100000
150000
200000
250000
300000
192966146128
52728 51563
65558
72299
28879 28256
Female Male
Pers
on
36.1%
39.9%
97.8%
97.8%
110%
75.7%
Source: Report on HIV and Drug for UB50, VAAC – Sep, 2013; D28 – Quarter 3, 2013; EPP, 2012
Community clinical services are the glue
• DICs – safe spaces at center of clinical services for KPs
• Clinical outreach led by non-stigmatizing health care workers and key populations leads
• A case management approach – training KP community workers to reach and support peers over time to keep them linked to clinical services, sustain retention and bolster ART adherence
Improved retention in care
Etienne et al 2007
Thank you!