Background: Differentiated service delivery (DSD) is a patient-centered approach to HIV care that allows patients to receive services tailored to their individual needs. Aimed at increasing health systems efficiency, many DSD models let medically stable patients receive community-based healthcare services, reducing their need to travel to health facilities (HF). Since 2016, ICAP has supported DRC''s National AIDS Control Program (NACP) in the scale-up of PODI, community-based ART distribution centers. The PODI model decentralizes ART refills to the community, separating refill visits from clinical appointments.
Description: In Kinshasa, ICAP has supported the establishment of two PODIs, PODI-East (January 2016) and PODI-West (July 2017). ICAP has trained and mentored to lay community health workers (CHW) responsible for the care of patients at PODIs. Eligible patients, those who are >15 years and on ART for 12 months and virally suppressed (“stable”), are referred to PODIs by providers at HFs where they receive care. Patients visit PODIs quarterly for ARV pickup and to receive adherence counselling, basic symptom screening, and index HIV testing for family members. Patients return to HFs annually for clinical check-ups and can be referred back to HFs if they require additional medical care.
Lessons learned: Since 2016, a total of 2,027 patients have enrolled at ICAP-supported PODIs. Of these, 80 (4.0%) were LTFU, which prompted tracing by CHW, 31 (1.5%) died, and 171 (8.0%) were referred back to a HF. Providing support to health care workers on eligibility criteria for PODIs and CHW for patient follow-up activities, and ensuring patients received adequate adherence counselling were critical to the success of this strategy.
Conclusions/Next steps: PODIs serve as a promising community-based model of care that addresses many of the health system challenges of providing lifelong treatment to stable HIV patients. Given that PODIs are co-located at community venues, patients are able to refill their ARVs close to home without having to visit a HF. Task-shifting ART monitoring and refilling to CHW allows providers at HF to spend more time with less stable patients. ICAP is working with NACP to expand the PODI model to Lubumbashi and plans to conduct an evaluation to inform the national scale-up plan.