Suchergebnisse

Background The adoption of the UNAIDS 90-90-90 targets acceleration plan and the implementation of 'test and treat' strategy has resulted in a significant increase in the number of people living with HIV/AIDS (PLWHA) receiving lifelong antiretroviral therapy (ART). To improve and sustain ART retention in care and virologic suppression, innovative service delivery models are needed. In 2010, Médecins Sans Frontières (MSF) set-up decentralized community ART refill centres ("poste de distribution communautaire", PODI) for follow-up of stable ART patients from Kabinda Hospital (CHK), in Kinshasa, Democratic Republic of Congo. Objective To assess retention in care and virologic suppression on ART after transfer to the three main PODIs in Kinshasa. Methods A retrospective cohort study was conducted using routine program data for PLWH aged >15 years and stable on ART transferred from CHK to a PODI between January 2015 and June 2017. Kaplan-Meier analysis was used to estimate retention in care. Viral load (VL) suppression was defined as a VL ≤ 1000 copies/ml. Results A total of 337 patients were transferred to a PODI. Of these, 306 (91%) patients were on ART 12 months after transfer to PODI and were eligible for the 12-month routine VL testing. A total of 118 (39%) had VL done at 12 months; VL suppression was 93% (n=110). Median time from enrolment into PODI to 12-month routine VL was 14.6 months [IQR: 12.2-20.8]. Overall, 189 (62%) patients had at least one VL load test done during follow-up. Retention in PODI at 6, 12 and 18 months was 96%, 92% and 88% respectively. Retention at 18 months was statistically different between PODIs; 91%, 88% and 78% in PODI East, PODI West and PODI Central respectively, (p=0.0349). Conclusion Retention and VL suppression in community-based ART refill centers were high, although VL coverage was low. HIV programs need to scale–up VL testing services PLWHA receiving ART in PODIs.