Title

Improving retention, viral suppression, and facility decongestion through community-based individual drug distribution (PODIs) in DRC

Presenter

Eula Mothibi

Authors

E. Mothibi¹, J. Mangoma², D. Kabamba², L. Monteith², F.X. N'siesi³, J. Firth⁴, J. Kiluba⁵, D. Kamhere⁶, F. Chirowa⁷, B. Makumbe², A. Grimwood², G. Fatti⁸

Institutions

¹Khethimpilo, Health Systems Strengthening, Cape Town, South Africa, ²Khethimpilo, EQUIP, Cape Town, South Africa, ³USAID, Kinshasa, Congo, Democratic Republic of the, ⁴EQUIP, Washington DC, United States, ⁵IHAP, Lubumbashi, Congo, Democratic Republic of the, ⁶IHAP, Kinshasa, Congo, Democratic Republic of the, ⁷Khethimpilo, EQUIP, Harare, Zimbabwe, ⁸Khethimpilo, Cape Town, South Africa

Background: Current estimates of PLHIV in the DRC is 370,000 with 33% (122,268) on ART (UNAIDS 2015). While scale-up is ongoing to increase patients on ART, strategies to achieve retention and viral load suppression are essential. Monthly patient visits, provider prescribing, and dispensing of medications creates congestion at clinics and pharmacies, additional time and economic burden on patients, and additional data collection and tracking burden on M&E systems. EQUIP is implementing an out-of-health facility, community-based individual drug distribution (PODI) point from which clients can pick-up their medication and receive psychosocial support and other additional services.
Description: With the support of EQUIP, PROVIC Plus (now IHAP) established PODIs in Lubumbashi, and Kinshasa. EQUIP trained local supporting partners, NGOs and MOH staff on PODI setup, created SOPs, tools and registers to use for performance tracking. PODI members are adults >18years who have been adherent to treatment for the last 6 months. At each PODI visit, lay NGO staff members, who are mostly PLWHIV, do a symptom screen, provide peer support and issue three months'' ARV supply to the client. Symptomatic members are referred to the health facility for care. Annual, viral load tests are conducted. Monitoring tools track enrolment and missed appointment, retention, adherence and viral load suppression.
Lessons learned: In Lubumbashi PODI Kenya was set up in October 2016 and PODI Lubumbashi in January 2017. In Kinshasa, PODI Masina and PODI Kingasani were set up in 2017. By September 2017, a total of 1484 ART clients were enrolled at the 4 PODI houses resulting in decanting of linked facilities by 44%- 47% respectively. The four PODI houses show high retention rates of 92-100% at 3, 6 and 9 months and Viral Suppression above 90%. Some of the benefits of PODI houses include reduced costs to the patient and improved convenience for patients without compromising the quality of care.
Conclusions/Next steps: Shifting of ART delivery to Community Distribution points implemented as a differentiated model of ART provision for stable patients produces good retention and viral load suppression. This model can also provide benefits of decongesting facilities to enable rapid Test and Treat.

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