Stay On - sustaining successes for the next decades
Stay On - sustaining successes for the next decades
Are we equipped to retain all people living with HIV in care in a sustainable way? How can we ensure people live a fulfilling and productive life despite a complicated infection?
With a growing number of people living with HIV on treatment, retention in HIV care is important for a number of reasons. First of all, it is required for keeping people alive, optimal clinical outcomes, preventing medical toxicities, and identifying treatment failure in order to switch regimens when necessary. AIDS is still the leading cause of death among young people (aged 10–24) in Africa, despite having all the tools for a person to grow old with HIV. Secondly, it is proven to have a great impact on HIV incidence reduction. Hence, it is a vital component of combination prevention, for instance through prevention of mother-to-child transmission and U=U. Thirdly, intermittent adherence can have severe consequences such as emergence of drug resistant mutations, which will limit future drug options and increase mortality.
Differentiated HIV care in Ethiopia, Mozambique and Nigeria
People’s capacities and vulnerabilities differ greatly due to factors such as sex and age. Therefore differentiated care is always preferred.
In Ethiopia, Mozambique and Nigeria, funded under the Aidsfonds Stay On call, three partner organisations currently are implementing their contextualized approaches to ensure people with HIV will grow old in good care:
Ethiopia: Integrated Provision of HIV/SRH Services for Sex workers & Sustainable Retention in Care
Family Guidance Association Ethiopia (FGAE) works towards increasing demand for adherence to HIV treatment among female sex workers , and improving access to comprehensive, non-discriminatory quality HIV treatment and care through trained health service providers.
In 2021-2022 the project managed to reach a total of 35,473 female sex workers by demand creators who received peer education on HIV prevention, care and family planning option. Among them 15,982 clients were tested and 319 were diagnosed with HIV. 317 started anti-HIV treatment within the Stay on Project supported female sex workers-friendly clinics. In these clinics, currently 1247 clients are taking their anti-HIV treatment and close to 90% had optimal viral suppression by end of 2021.
FGAE works directly with former sex workers as peer demand creators. These women reach out to their peers and link them to one of the 10 project-supported clinics that provide integrated HIV and SRHR services in a sex worker friendly manner.
The project is implemented in 8 strategically located hotspot cities in Ethiopia, including the capital city Addis Ababa. The HIV prevalence among female sex workers living in these areas range from 27%-33% (2013), while the average national HIV prevalence rate for the general population is relatively low at 0.9% (2016).
Mozambique: Together we Stay On
ADPP Mozambique creates support groups to empower young (aged 15-25) and adult (25-59) women and men, including female sex workers, to overcome the challenges of dropping out of treatment. These groups all work around the same concept; people with HIV are supported by peer educators who are trained to supporting disclosure, access treatment and adherence, next to other subjects including HIV hygiene, nutrition and income generation activities.
This approach has proven to be effective and the local government recognizes the benefits of support groups. A number of 1053 support groups were established during the project that have improved the demand of voluntary testing in health facilities, community dialogues on HIV- testing and support, have increased testing events at communities and high schools: in year 2, 3,747 people with HIV accessed health facilities to start going back on treatment (compared to 1,766 people with HIV in year 1). A total of 2370 re-integrated. The no-integration of 189 people with HIV were related to deaths, change of residence, start of treatment in other health facilities distant from the area of residence.
Nigeria: Integrated Care and Support for People Living with HIV
YouthRISE Nigeria works with 3 groups of people living with HIV: people who inject drugs, female sex workers, and adolescent and young people (15-24 years old). The project makes use of existing structures in Nasarawa state and aims at strengthening existing HIV treatment, care, and support services. For example, children of sex workers (aged 5-15) that are living with HIV, are also linked to youth-friendly activities and support groups, when accessing public health facilities for HIV treatment, to enhance treatment uptake.
Despite the COVID-19 pandemic posing challenges on the progress of the project, YouthRISE Nigeria has been able to reach over 12.500 people living with HIV in 2020 and 2021.This means that after two years, they have been able to ensure 100% HIV treatment coverage among the target groups.
In addition, YouthRISE Nigeria applies a comprehensive approach by also offering structural interventions such as economic empowerment to ensure people with HIV can financially support themselves and have the financial means to afford ARVs and visits to health facilities. Nutritional support is also provided, to stay healthy and also essential in achieving viral load suppression.
About the Stay On call
As a growing number of people living with HIV are on treatment, Aidsfonds’ Stay On call looks ahead and broadens the focus from saving lives to sustaining successes for the next decades. With the call, Aidsfonds aims to support civil society organisations to develop, implement, and monitor interventions to sustainably retain people with HIV in care. Of course this has a strong focus on those most vulnerable to drop-out and is in line with the Universal Health Coverage commitments.
Here you find a success story of a 23-year old girl, who turned school teacher after being a sex worker from a young age.