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Demand driven DSD policy development The experience of Sierra Leone

This presentation discusses the development of a demand-driven differentiated service delivery (DSD) policy for HIV in Sierra Leone, considering the country's context, specific populations, and clinical characteristics. It covers the process of policy development, the key components of the DSD policy, and the next steps for policy implementation.

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Demand driven DSD policy development The experience of Sierra Leone

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  1. Demand driven DSD policy developmentThe experience of Sierra Leone Consultation on differentiated ART delivery in WCA Martin Philip Ellie (MSc Dev, MPH) & Dr. Samuel P.E Massaquoi (MB.CHB, MPH, Executive MBA) NACP Ministry of Health and ITPC – Sierra Leone 17th May 2019 – Accra, Ghana

  2. Background on Sierra Leone • Sierra Leone is a democratic Western African country with an estimated seven million people • Peaceful change of government in April 2018 • Being a pluralistic ethnic society, the country is divided into three political regions and 16 districts

  3. Slide Title

  4. HIV in Sierra Leone • Adult prevalence is 1.5% • 61,000 PLHIV in Sierra Leone (UNAIDS, 2017; DHS, 2013) • Prevalence among women is 1.7%, prevalence among men is 1.3% • Highest for women 2.6%, ages 35-39 • Highest prevalence for men is 2.9%, ages 30-34 • Adult prevalence in urban areas is 2.3%, rural areas is 1.0% • 64-43-30 against 90-90-90 targets • HIV services- 708 testing sites, 305 treatment sites (inclusive of PHUs and district hospitals)

  5. Process to develop DSD policy • The 2014 Ebola viral disease outbreak had a crippling impact on the health delivery system • Uptake of HIV services became a serious challenge • An impact mitigation project was approved by the Global Fund to support treatment uptake and adherence • PLHIVs in quarantined households and districts had ART refill delivered to them through their peers • Through this effort, over 3,500 clients either received their ART refills directly from their peers or were brought back to care by peers

  6. Process to develop DSD policy • With the introduction of ‘Test and Treat’, key partners (particularly PLHIV network and UNAIDS) pushed for DSD implementation • The Community Treatment Observatory (CTO) provided evidence which was used by NETHIPS to engage relevant stakeholders on the benefits and need to start DSD in Sierra Leone • Process started with situational analysis carried out to understand how DSD was practiced in the country • With funding from UNAIDS, a steering committee was set-up to support the process • situational analysis, policy development and validation • Key players in the policy development were: National AIDS Secretariat, National AIDS Control Program, UN Family, civil society including NETHIPS and international non-governmental organizations

  7. Overview: Sierra Leone DSD policy • DSD policy takes into consideration context, specific populations and clinical characteristics • The policy differentiates services for adults, children, adolescents, key population, pregnant women and unstable patients • Covers entire continuum of care: • Testing and linkage are differentiated for the above sub-populations • ART initiation is done after assessment of patient’s clinical and psychosocial readiness • On ART: Stable clients on ART receive their refill for three months and are seen individually every six months by a trained clinician (nurse, physician’s assistant, HIV counsellor or doctor) • Clients with high viral load or advanced disease are attended at the ART sites • Policy proposes patient education to increase uptake of viral load service

  8. Includes definition for stable child

  9. Lay provider distribution of standardized 3m ART refills

  10. Next Steps: Policy to implementation • Print and disseminate validated DSD Guidelines to all stakeholders • Train Master Trainers on DSD to cascade training to subnational levels • Support PLHIV Network (support groups) to form Community ART Groups for stable clients • Increase community demand for DSD through PLHIV support groups • Repeal discriminatory laws against key population

  11. Next Steps: Policy to implementation • Procurement and supply chain management should align with three months ART refill for stable clients • Mobilize financial resources to fully implement DSD, especially for children, adolescents and young people, KPs, community ART models for stable clients and clients with advanced HIV disease

  12. Thanks

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