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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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