Out-of-facility individual models

Community-based points of ART distribution (PODI), Democratic Republic of Congo (DRC)

In 2016, DRC adopted “test and treat”, leading to overwhelming clinic caseloads for healthcare workers, as well as extreme waiting times for patients at overburdened clinics. In two provinces in south-eastern DRC, community-based points of ART distribution called PODI (points de distribution), an out-of-facility individual model, were introduced and offered to clients, along with two other treatment models.

Impact: Three PODI sites were established, supporting 1,848 client who are established on ART. High rates of retention have been observed (94.9% at six months, 89.3% at 12 months and 82.4% at 24 months) and transport costs have been reduced by two-thirds. The waiting time for a PODI ART refill is 12 minutes, compared with 85 minutes in the hospital.

Eligibility

15 years or older, 12 months on ART, virally suppressed, no opportunistic infections in the past three months. Pregnant women are not eligible.

Building Blocks

ART refills

What

ART refill
TB screening
Adherence check
Peer support

When

3 monthly

Where

PODI (community based)

Who

Expert client (person living with HIV) Doctor

Clinical consultation

What

Clinical assessment
Laboratory investigations
Rescripting

When

Annually

Where

Health facility

Who

Doctor

Variations for Specific Populations

Drop-in-centres for gay men and other men who have sex with men, Ghana

The Ghana national DSD operational manual has endorsed a model for primary health centres, community sites and key population drop-in centres to function as ART refill sites. Drop-in centre refill…

Community drug distribution points (CDDPs), Uganda

In Uganda, clients were travelling long distances to overcrowded facilities with long queues to collect their ART. The AIDS Support Organization (TASO), a local non- governmental organization (NGO), initially responded…

Community-based points of ART distribution (PODI) and TB service integration, Democratic Republic of Congo (DRC)

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…

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…