13 September 2017

Uganda: New HIV Treatment Model to Reduce Hospital Crowds

Health officials have advised people living with HIV to embrace the Differentiated Service Delivery (DSD) model that aims at treating HIV infections, reducing overcrowding at health centres and long waiting hours, as well as encouraging patients' adherence to drugs.

According to Dr Achilles Kiyimba, the project manager, Western and West Nile HIV project at the Infectious Diseases Institute, DSD also improves access to antiretroviral therapy (ART) services and maximises use of community human resources.

"It addresses current problems of people living with HIV, which include frequent health facility visits, high travel costs, over-crowding, long waiting times at facilities, over stretched health systems and poor quality services," he said.

Kiyimba said DSD is promoted by the latest World Health Organization (WHO) guidelines for preventing and treating HIV. It is a policy requirement for the country to address the increased number of HIV clients.

"The number of people living with HIV is increasing, but the health facilities and workers are not increasing. Some health workers are running out of health centres due to overworking. With this model, the workload on the health workers will reduce and they will provide better quality services to the few clients who come to the facility. We want to leave the health facilities to clients who are just starting their treatment and must see the doctors, or those with complications," he said.

Kiyimba said, "Due to long waiting hours, we have noted that some clients are shunning health facilities and others disappear because they can't wait for long. This means they miss drugs which is very dangerous because the virus will become resistant."

Kiyimba said the DSD model saves time for people who are knowledgeable about taking ARVs and don't need to see specialists, but just pick drugs and go.

"This system is called PharmacyOnly visits, where people only pick drugs and go since they only want to refill. This helps them not to wait in queues," Kiyimba said.

The DSD model has two systems that include testing and treating. Under this, they have different models that include the Community Client-Led ARV Delivery (CLAD) model and community drug distribution points.

In CLAD model, they only consider people who are stable on treatment and have suppressed the virus, to avoid resistance.

"Those who are positive and willing to form small groups of stable clients at health facilities, know each other, disclose their HIV status, and choose one person every month to pick drugs on behalf of others from health facilities. This helps them to save transport costs, avoid long waiting hours and overcrowding the facility," Kiyimba said.

In the CLAD model, the group members keep changing the person who picks their drugs. In the other DSD model of community drug distribution points, a health worker identifies a post within the community that is nearer to the clients, picks drugs from the main health facility, and puts them at the distribution point for easier access.

"So the clients within that area pick the drugs from that point which could be a church, mosque, school, playground... [instead of] travelling to big health centers," he said.

In the DSD model of 'Test and Start', if someone tests HIV-positive they are advised to start treatment immediately to reduce chances of spreading the virus, since people on ARVs have reduced chances of infecting others.

Dr Josen Kiggundu from the ministry of Health said they are conducting both national and regional training to all health workers on how to handle DSD efficiently.

"The DSD model is part of the consolidated guidelines launched last year by ministry of Health to approach patient care, focused on the preferences and expectations of people living with HIV," he said.

Sylvia Nakasi, the policy research and advocacy officer, Uganda Network of Aids Service Organisation (UNASO), said DSD "will increase on the quality of services, number of clients on treatment and reduce stigma for people who don't want to pick drugs from the health centers. They had been sending boda boda cyclists and maids to pick drugs for them".


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