For people living with HIV, the chances of developing AIDS or another serious illness is considerably lower the sooner one begins antiretroviral treatment (ART). Additionally, a suppressed viral load helps prevent perinatal transmission of HIV and leads to less likelihood of HIV transmission to sexual partners.
With funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), ICAP in Tajikistan collaborated with the Republican AIDS Center and local partners to execute revisions to national guidelines outlining that people living with HIV should be initiated on ART within seven days of diagnosis.
Previously, national guidelines stated that ART prescription for an individual diagnosed with HIV could be anywhere from two to eight weeks. Several obstacles, including stigmatization of an HIV diagnosis and HIV-related health appointments, lack of diagnosis acceptance, and limited guidance for health care professionals prescribing ART, also impeded the process of getting people living with HIV the treatment they needed, and fast. In 2020, there were 9,500 people living with HIV in Tajikistan who knew their status and only 8,000 on ART.
“This new guideline will make a major difference in the health of people living with HIV and those at risk of acquiring the virus,” said Zumrad Maxumova, MD, PhD, ICAP national coordinator in Tajikistan. “Timely initiation of ART is critical to achieving viral suppression and is one of the main factors in ending the HIV epidemic globally.”
Updating national HIV guidelines can mean a small change with a major impact. Institutional and government support behind new HIV health facility procedures not only helps health care providers prioritize how to best address an individual’s health needs but signifies the value of addressing such areas as the HIV epidemic, which globally continues to bear stigmatization.
To ensure streamlined implementation of the new guidelines, every two weeks ICAP and health facility staff used patient data to evaluate the number of days between HIV diagnosis and ART initiation. Cases of delayed ART initiation were analyzed and discussed with facility staff to develop a performance improvement plan. To further motivate prompt initiation on ART for people living with HIV, ICAP in Tajikistan also introduced quarterly performance-based incentives to members of site-level clinical teams, including physicians, nurses, and peer consultants.
“ICAP also proposed to ensure introduction of lifelong ART for everyone, regardless of the number of CD4 [a measure of the strength of your immune system] cells, including children, adults, and pregnant and lactating women living with HIV,” added Maxumova.
From January to May 2022, a total of 296 new cases of HIV infection were detected at 45 PEPFAR-supported sites. Of these, 278 people living with HIV started ART within the newly recommended seven-day period.
As a result of ICAP’s support to help end the HIV epidemic in Tajikistan – including such efforts as development of national guidelines, site-level mentoring of providers to improve HIV testing and treatment, roll-out of pre-exposure prophylaxis (PrEP), and development of a confidential electronic HIV case management system – ICAP in Tajikistan was recently awarded a Certificate of Appreciation by the Ministry of Health at the country’s National HIV Forum. Nearly 100 people participated in the forum, including representatives of government agencies of Tajikistan, non-governmental organizations, grantors, and international partners such as the United Nations Development Programme (UNDP), UNAIDS, and CDC.
“ICAP and its partners have made a great deal of progress in addressing HIV in Tajikistan, but there is still a lot of work to be done,” said Anna Deryabina, MD, DrPH, MScIH, ICAP regional director in Central Asia. “ICAP in Tajikistan works to address HIV service quality improvement from all levels. This comprehensive approach is essential because it helps address the existing gaps and ensure sustainability of the quality improvement efforts. In the future, we hope to continue building capacity of local clinical teams to provide quality and patient-focused HIV services in order to achieve the UNAIDS 95-95-95 goals.”
A major global health organization that has been improving public health in countries around the world for nearly two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 30 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu