HIV/AIDS response: Embracing flexible health systems

By Dr. Jennifer Namusobya

During this year's International AIDS Society conference held in Durban, South Africa, there was a unanimous outcry for health systems to adapt away from a ‘one-size-fits-all' approach so as to effectively meet the individual needs of the ever-increasing number of People Living with HIV (PLHIV). From the world's best brains in HIV/AIDS service including researchers, doctors, innovators, policy makers and donors, the concept of differentiated care - a client-centered approach that simplifies and adapts HIV services to reflect the preferences and expectations of specific groups of PLHIV while reducing unnecessary burdens on the health system - strongly  stood out.

Closer home, with an estimated 1.5 million Ugandans living with HIV, 30% of whom are yet to be diagnosed, and only about 61% PLHIV accessing the life-saving anti-retroviral drugs, a clarion call is out to AIDS workers to find new ways of how to increase the number of people getting quality HIV care within the available resources. We can no longer afford to use a ‘one-size-fits-all' approach in HIV care.

This World AIDS Day, as we celebrate the gains in the AIDS response and ponder on ways to achieve the ambitious yet achievable UNAIDS Global commitment to end AIDS by 2030, we must remain cognizant of the need to focus on the individual needs of the people that we serve.

The Government of Uganda through the Ministry of Health, launched the "Test &Treat" guidelines on November 29th, 2016. With these new guidelines, every person who tests HIV positive should be given Anti-Retroviral Treatment (ART) as soon after diagnosis as possible. It is envisaged that implementing this approach will improve the lives of PLHIV, reduce AIDS-related deaths, reduce new infections, and stop AIDS by 2030.

However, this approach will certainly put pressure on the health system which is already strained due to inadequate human, financial and other resources. The Government of Uganda together with the development partners (who currently contribute about 70% of the resources for HIV/AIDS services) have made the necessary provisions to enable implementation of this new approach. However, in order to make the most of the available resources yet respond effectively to the immense and growing need for HIV services, it is important that we are flexible and adaptable enough to embrace models of care specific to the individual needs of our clients.

So how different is differentiated care? By adopting the differentiated models of care, we refocus resources to those most in need. A person living with HIV who adheres well to treatment need not queue to see a doctor or a counselor every month before collecting their ART refill at the pharmacy. That person can go direct to the pharmacy and pick drugs or better still, receive a three to six months refill. The health worker, on the other hand, will have fewer clients to see and therefore be able to give adequate attention to those who need it most. Similarly, one family/community member can collect drugs on behalf of consenting family/community members. This again frees up time for both the clients to go about their normal business, and health workers to support those that are failing their treatment.

Differentiated care also involves shifting of tasks to new cadres in the health system, including community health workers and client-led groups, following proper training and supervision to maintain quality of the services provided. These and more evidence-informed models of care have been proven effective here in Uganda and many other countries in Africa.

Ultimately, differentiated care puts the client at the center of service delivery thereby enhancing client experience while ensuring the efficiency in the health system functionality. There is much more work yet to be done if we are to usher in an AIDS-Free generation sooner than later, and embracing and scaling up evidence-informed innovations like differentiated care is only but a step in the right direction.  

The writer is the executive director, MJAP