Access to treatment

Purpose

Improved community access to and utilisation of treatment services.

Results

  • Increased levels of quality innovative initiatives that reach out to populations usually left out of activities in mainstream HIV responses.
  • Increased support to development and replication of innovative models of effective community HIV responses with increased scale and coverage.
  • Improved sharing and learning about effective community responses.

Target populations

The projects directly target people living with HIV and workers in the health system.

Geographic scope

Projects are being implemented in Zambia and Burkina Faso. The ART Community Education and Referral (ACER) project is being implemented in Ndola, Lusaka and Kazungula in Zambia. Projet Orange is being implemented by Association African Solidarité (AAS) in Ouagadougou in Burkina Faso.

Background

The ACER project in Zambia and Projet Orange in Burkina Faso were conceived as two separate projects. They share a common aim of increasing access to treatment services at the community level but they piloted different approaches.

The ACER project began as an operations research project (findings due in mid-2007) exploring the importance of community engagement in ART and expanding access to treatment services. The ACER project links existing community organisations and support networks – traditional healers, home carers, positive people’s groups and church groups – with government health services. The project employs people openly living with HIV to promote uptake of treatment, to support treatment adherence and to promote prevention efforts in community and clinic settings.

Projet Orange was designed to pilot a model to scale up access to treatment through a civil society organisation in Burkina Faso, where access to treatment is limited to those with the ability to pay for drugs. The project piloted the provision of ART through a not-for-profit clinic, which provides ARVs and comprehensive medical and support services to those with HIV. With support through the ARP, AAS has developed and been able to take on a national advocacy role for expanded treatment services.

Although the two projects have taken different approaches, with ACER developing community referral systems to link to the government health system and AAS establishing a health centre to provide community members with treatment services, the projects share the same objectives. These are to:

  • increase access to treatment
  • improve treatment adherence (integrate adherence support into care and support for people with HIV)
  • advocate for increased access to treatment

ARP has provided funding to both these projects and also funded exchange visits for personnel from ACER and AAS to visit and learn from each other’s programmes. In 2007, the learning from these two projects will be consolidated and shared through a case study.

Project strategies

ACER project strategies:

  • Community education on voluntary HIV counselling and testing (VCT); antiretroviral treatment; adherence, prevention and stigma reduction.
  • A two-way referral system between the community and health system including referrals for VCT, ART and psychological and social support.
  • People living with HIV are employed to work as Treatment Support Workers (TSWs) in the government ART clinics alongside the health care workers. The TSWs act as referral contacts and guides for people attending the clinics and provide information and support on ART, adherence counselling and support prevention.
  • Further adherence support in the community, through home-based care programmes and support groups.

Projet Orange project strategies:

  • Provision of ARVs and drugs to treat opportunistic infections.
  • Provision of regular medical and laboratory check ups.
  • Social support (nutrition, micro-credit).
  • Conduct regular positive living support groups, self-support groups, treatment adherence support groups and treatment literacy.

Lessons learned

  • The two-way community referral system has been a key feature of the ACER project. It has been instrumental in ensuring that people gain access to the health system and other forms of support when they need it, and that they are followed up when they return to the community.
  • The participation of people living with HIV helps to reduce stigma: experience in ACER has shown that working with well-trained people with HIV who are on treatment themselves and stationed in health facilities helps to reduce stigma in the health facility and in the community. We have noticed that people feel free to share their experiences with fellow people with HIV and in their community regarding issues of living positively and HIV treatment.
  • Projects have to remain dynamic to respond to success as well as challenges. The success of the projects has resulted in patients identifying additional needs and wishes such as the desire to have children, to be able to return to an active life and economic self-sufficiency. Both projects have developed additional interventions such as positive prevention support groups, and referral to livelihoods programmes.