An interview with Didier Kamerhe, Community Prevention and Treatment Advisor at PATH in the Democratic Republic of the Congo (DRC).
We had the opportunity to speak with Didier about his work in PATH’s Integrated HIV/AIDS Project and find out more about the community ART distribution point model, HIV/tuberculosis service integration and upcoming priorities for differentiated service delivery (DSD) in the DRC.
Can you tell us about your work and why you decided to pursue a career in the HIV field?
I am a medical doctor and public health specialist for community health, based in the Democratic Republic of the Congo (DRC). In the past, I worked in clinics and specialized programmes of the Ministry of Health of the DRC. I currently work at PATH in the Integrated HIV/AIDS Project as the Community Prevention and Treatment Advisor.
My key tasks at PATH are to supervise the planning and implementation of project activities related to differentiated community-based counselling, testing, care and support models. I also provide technical support to health zone management teams to conduct a micro-analysis of the HIV epidemic in their respective zones. Lastly, I lead operations research or studies to evaluate the effectiveness or impact of community-based differentiated service delivery models.
I decided to pursue a career in HIV programming and research because I have passion for this work and because several people in my community, very close to me, live with HIV and must take antiretrovirals for life. I want to offer them the best possible care.
What are the current and upcoming priorities of your DSD-related work in the DRC?
It will be key for us to define how to sustain the community ART distribution point (points de distribution communautaires, PODI) model after PEPFAR funding ends, especially since it is the model that clients most prefer.
Among the priorities of our project are efforts to extending the fast-track circuit model in all sites with a high client volume. We have also introduced peer educators into this model to provide additional care and support to clients because tuberculosis (TB) and nutritional screenings are not yet systematically provided. In addition, we plan to engage peer educators for TB contact tracing in the community for those people living with HIV who are diagnosed with active TB; we also intend to facilitate transportation of sputum samples to the TB diagnosis and treatment centre.
With your expertise on HIV/TB co-infection, please could you elaborate on recent efforts towards integrating TB screening and TPT into the community ART distribution point model?
We introduced TB screening and TB preventive therapy (TPT) into the community ART distribution point model which means that people living with HIV are screened for TB at every ART pick-up appointment. Those who screen positive are referred to the TB diagnosis centre for confirmatory diagnosis, and those who screened negative are initiated on isoniazid preventive therapy. Peer educators facilitate active TB contact tracing at the community level for people living with both TB and HIV. Our main observations were the high TB screening rate (97%) among clients enrolled in the PODI site and the low proportion of stable clients enrolled in the DSD model with active TB (less than 5%).
Congratulations on winning an IAS/MSD Prize for Operational and Implementation Research in Differentiated Service Delivery for your IAS 2019 abstract. Please could you provide some background on the DSD model presented in your abstract and your lessons learnt from this study?
The aim of the DSD model implemented by the project in the DRC is to accommodate preferences of people living with HIV while reducing burdens like repeat clinic visits, long travel distances and lengthy waiting times that may negatively affect retention in care. At the Kenya General Reference Hospital in Lubumbashi, we compared 12-month retention outcomes for clients enrolled in the DSD model with outcomes for those who remained in the traditional model. After 12 months, 98% of people living with HIV in the DSD model were still in care versus 89% in the traditional model; people living with HIV enrolled in the DSD model had a viral suppression rate of more than 95% compared with 74% in the traditional model.
Notably, a client’s education level and age at ART initiation, which may indicate greater treatment literacy and self-efficacy in seeking health services, were predictors of a preference for differentiated service delivery. Increasing treatment literacy could also lead to greater uptake of DSD models and thus improve quality of care and treatment outcomes for people living with HIV.
