In Uganda, The AIDS Support Organization (TASO) has been providing differentiated HIV treatment for more than 10 years. ART distribution was first decentralized to community drug distribution points (CDDPs) and then to community client-led ART delivery (CCLADs). In 2017, a group of female sex workers advocated for the establishment of specific CCLADs led by and for female sex workers. A CCLAD is a group of people living with HIV from the same geographical area being put together into a peer support group of five to ten members. The group selects a peer leader who is responsible for collecting 3-monthly ART refills from the nearest CDDP. The peer leader then distributes the refills to the CCLAD members at the agreed venue, documents the distribution and monitors the treatment among her peers. CCLADs for female sex workers follow the same structure, but are comprised of female sex workers. The female sex worker-led CCLAD is an example of a client-led group model of ART delivery.
Impact: Between October 2016 and June 2017, a behaviour change campaign reached more than 7,000 female sex workers. A total of 5,775 HIV tests were completed and 525 people living with HIV were identified (positivity rate = 9.1%). Of those identified as HIV positive, 81.5% (n=428) were linked to care and 23.6% of those linked to care were initiated on ART (n=124). Over the same period, a cumulative number of 215 female sex workers were in care, with 89.8% on ART, of which 90.9% were virally suppressed. A year later, in 2018, all the 24 female sex workers in the four CCLADs remained virally suppressed.
Eligibility
Female sex workers who are established on ART (virally suppressed, on first- or second-line ART for at least six months and are at least 15 years of age).
Building Blocks
ART Refills
What
ART refill distribution, peer psychosocial support, peer adherence monitoring, psychosocial support
When
Every two months, 6 times/year
Flexible service hours, decided
Where
Community drug distribution points
Who
Group-nominated female sex worker peer leader distributes pre-packed ART
Clinical consultation
What
Nutrition monitoring, adherence measurement, TB screening, STI screening, OI examinations if any, lab investigation (VL and CD4), weight monitoring, mental health screening, dosage adjustment as required
When
Semi-annually (2 times/year)
Where
Primary care clinic
Who
Doctor or clinical officer
Psychosocial support
What
Peer psychosocial support
When
At each clinical visit; within the group at each refill
Additional support as required
Where
Community
Who
Group-nominated female sex worker peer leader
