In 2016, the DRC adopted “test and treat”, leading to increases in clinic caseloads for healthcare workers, as well as extended waiting times for clients. In two provinces in south-eastern DRC, community-based points of antiretroviral therapy (ART) distribution called PODIs (points de distribution), an out-of-facility individual model, were introduced and offered to clients, along with two other treatment models.
Three PODI sites were established, supporting 1,848 clients who were established on ART. High rates of retention were observed (94.9% at six months, 89.3% at 12 months and 82.4% at 24 months) and transport costs reduced by two-thirds. The waiting time for a PODI ART refill is 12 minutes, compared with 85 minutes in the hospital.
Clients are screened for tuberculosis (TB) at each visit and referred to the health facility if the screen is positive. If a client is eligible for tuberculosis preventive therapy (TPT), they receive isoniazid (INH) from the community site monthly for six months. ART refills continue to be given every three months. ART and INH are dispensed by peer educations who are trained and recognize the signs and symptoms of side-effects of both ART and INH. If clinical problems arise, the peer educator escorts the client to the health facility.
Eligibility
At least 12 months on ART, virally supressed, nil opportunistic infections in the past three months, 15 years or older and not pregnant.
Building blocks of TPT within PoDi+
Screening for TB
What
Verbal symptom screen
When
Every three months
Where
Community ART distribution point
Who
Peer educator
Initiation of TPT
What
TPT eligibility assessment Initiation of IPT and pyridoxine TPT treatment literacy
When
For newly initiated, start at baseline and complete prior to entry into PoDi model If not had TPT, receive it at next negative TB screen
Where
Community ART distribution point
Who
Peer educator
TPT refill
What
Continued TPT treatment literacy TPT follow-up assessment (TPT side-effects and/or TB symptoms) Refill of INH and pyridoxine (only aligned every third month with ART refill)
When
Every month
Where
Community ART distribution point
Who
Peer educator
Completion of TPT
What
TB symptom assessment TPT completion documented in M&E systems
When
After six months
Where
Community ART distribution point
Who
Peer educator
Variations for Specific Populations
Drop-in-centres for gay men and other men who have sex with men, Ghana
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Community drug distribution points (CDDPs), Uganda
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Community pharmacies for ART refills, Nigeria
Community pharmacies in Nigeria are registered as private pharmaceutical premises. In 2014, there were 530 registered pharmacies in the capital city of Abuja. In this model, ART refill services are…
Key population organization-led ART delivery for transgender women, Thailand
In Thailand, health service delivery models were designed to improve HIV service uptake among transgender women and gay men and other men who have sex with men, as well as…
Paediatric outreach supported down-referral with appointment spacing for children, Zambia
In Zambia, children living with HIV needed to travel long distances to receive care at the central paediatric referral hospital. In response, the paediatric services developed a primary care outreach…
Integration of ART delivery into key population (KP) services, Haiti
To improve access to and support for uptake of HIV prevention, testing, treatment and care for gay men and other men who have sex with men and female sex workers,…
Community-based ART delivery for people who inject drugs, India
Injecting drug use is the primary driver of the HIV epidemic in the northeast region of India. India’s National AIDS Control Organization (NACO) implements targeted interventions: peer-led, community-level prevention programmes…
Further reading
Interested in in Leveraging differentiated ART delivery models for stable clients to scale up TB preventive therapy? Read more here. Also available in French and Portuguese.
Learn about TPT integration within adherence clubs in South Africa here.
Learn about TPT integration within facility fast-track in Zambia here.
