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In Central Asia, Patient-Centered Services Increase Access to HIV Care and Treatment
In 2010 there were more than 2.3 million people living with HIV in Eastern Europe and Central Asia—almost twice the number of people living with HIV in 2001. Despite the growing need for HIV care and treatment, less than 23 percent of people living with HIV in the regions were receiving antiretroviral therapy (ART). Access to comprehensive HIV care and treatment was complicated by a number of factors including inconsistent knowledge of the national ART guidelines, lack of coordination among clinicians, staff shortages, and limited distribution of ART medicines.
Thus in 2011, ICAP with funding from PEPFAR through the CDC, began working with the ministries of health and local partners at 19 HIV facilities in Kazakhstan, Kyrgyzstan, and Tajikistan to improve the quality of medical services for people living with HIV and increase patient retention in care and ART adherence by providing comprehensive patient-centered HIV services. ICAP’s support included direct mentorship of clinicians working at these facilities, as well as national training seminars on clinical management of HIV and TB/HIV co-infection, counseling, data analysis, disease monitoring, and clinical protocol revision in all three republics.
To improve the adherence of patients on ART, ICAP and partners launched several evidence-based approaches from implementing a text-message reminder system for patients on ART to spearheading the Home Visiting Nurse Service, which deploys clinicians to patient homes to provide counseling, medication, and to reengage individuals previously loss to follow-up.
ICAP has conducted more than 250 facility-based mentorship visits, trained more than 850 HIV specialists, and completed more than 7,800 home visits. “With the implementation of the comprehensive patient-centered care and treatment service-delivery model, we can see an improvement in the HIV services provided to patients, said Dr. Zhanna Mustafina, head of the clinical department at Karaganda Oblast AIDS Center in Kazakhstan. “The team-based approach is supporting continuous improvement in patient retention as well as adherence to ART.”
Since 2012, the number of HIV-positive patients enrolled in HIV care increased across all three republics from: 26 percent to 58 percent in Kyrgyzstan; 30 percent to 40 percent in Tajikistan; and 93 percent to 95 percent in Kazakhstan.
ICAP’s support has also enabled more people living with HIV to receive ART: in Kyrgyzstan the number of people on ART increased from 26 percent to 68 percent; from 48 percent to 63 percent in Tajikistan; and 22 percent to 31 percent in Kazakhstan between 2012 and 2015.
“Low adherence to regular HIV care and treatment and high rates of patients lost to follow up are among key challenges of effective epidemic control in Central Asia. These are encouraging outcomes that can help to improve the situation,” said Anna Deryabina, ICAP country director in Central Asia.”