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Abstract
Towards universal outcomes: a community-based approach to improve HIV care in post-conflict Liberia
R. Panjabi1, O. Aderibigbe2, W. Quitoe2, A. Duowolo2, P. Wiakanty2, A. Sunh2, J. Flomo2, T. Gandoh2, O. Davis2, S. Holkar3, J. Kraemer1, A. Muwan2, D. Tarlue2, K. Mamba2, V. Gaye2, M. Luogon2, S. Gausa2, B. Korboi2, M. Desuah2, N. Nowine2, D. Logan4, K. Bility2, B. Dahn2, W. Gwenigale2
Issues: Despite increased access to antiretroviral treatment (ART), patients receiving ART in resource-constrained countries often experience poor outcomes, including high default and mortality rates. Moreover, limited evidence exists from post-conflict countries, like Liberia, demonstrating successful ART delivery by rural public facilities.
Description: In March 2007, the Liberian Ministry of Health, in partnership with Tiyatien Health, a non-governmental organization, and with funding from the Global Fund, launched the HIV Equity Initiative (HEI): a comprehensive, community-based ART program in rural Tchien district in southeastern Liberia. Before project initiation, no patients in southeastern Liberia received ART and testing services functioned poorly. Besides providing free services, the HEI incorporated three innovative components to improve ART delivery: training non-physician clinicians to prescribe ART; providing socioeconomic assistance through food packages and transportation stipends; and employing community health workers (“accompaniers”) to provide supervised antiretroviral therapy.
Lessons learned: Between March 1, 2007 and January 31, 2008, of 852 patients tested for HIV, 128 (15.0%) were HIV-positive, of whom 48 (70.8% female) were adults enrolled on ART, with 37 (77.1%) receiving fixed-dosed stavudine/lamivudine/nevirapine twice daily. Accompaniers made 3948 home visits to ART patients. Among 30 patients receiving a mean of 5.8 ±3.6 months of supervised ART none (0%) were lost to follow up and 3 (10%) died, yielding an overall attrition of 10%. Mean weight gain for those treated for 6 or more months was 5.6 ±5.3kgs. In contrast, 18 patients received unsupervised ART for a mean of 3.5 ±2.9 months, among whom 5 (27.8%) died and 5 (27.8%) were lost to follow up, yielding an overall attrition of 55.6%.
Next steps: Our experience suggests high-quality HIV care can be delivered in rural Liberia using a comprehensive, community-based approach. Such approaches should be given greater consideration when designing treatment programs in other impoverished, post-conflict regions.
AIDS 2008 - XVII International AIDS Conference
Abstract no.
CDB0306
Suggested Citation
"R.Panjabi, et al.
Towards universal outcomes: a community-based approach to improve HIV care in post-conflict Liberia.
:
AIDS 2008 - XVII International AIDS Conference:
Abstract no.
CDB0306"
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