!
Female&sex&workers&(FSW)&in&Ethiopia&disproportionately&affected&by&HIV.&
Marginalized from the health services
• Don’t access public HIV testing services for lack of
friendliness
• Linkage to treatment and earlyART initiation a challenge• Only
72% of HIV positive patients in Ethiopia are put on treatment but
it is as low 26% among FSW.
• There are 193,270 FSW is Ethiopia,
• Most FSW linked to care don’t return after their first chronic
care visit.
• FSW’s reasons for not returning to care is:
• Service perceived as unfriendly
• Long waiting hours
• Lack of privacy/confidentiality
• Fear of stigma & discrimination
• Inconvenient operating hours
•
MULU/MARPs)(MULU))is)USAID!funded,'HIV'prevention'project'targeting'FSW
o Test and Treat approval !March 2016.
o CommunityART for FSW !August 2016
o Began offering HIV Care and Treatment in 25 FSW!friendly DICs
inOctober, 2016
.
• Data$capturing !"DHIS2"tracker"data• DIC$Features:
One$stop$service$!
By#well$trained$and$friendly$service$provider$(50$service$providers,$25$case$
managers,)pharmacists)and)laboratory)technicians)are)trained)on)key)pop.)Friendly)and)ART)
service'provision').
Time%flexibility%–
extending(and(convenient(working(hour(including(weekend.
Peer$support'– posttest&session
Strong'adherence(support(and$follow!up#Case#management'.Phone&call&reminder&and&praise&massage&(OES))
Table 1!
HIV$cascade$gap$comparison$between$general$population$and$FSW
1. BACKGROUND
▶ HIV$services$in$FSW!friendly)DICs)improved:!
Service'uptake'for'testing,'Positive'identification,'Linkage(to(treatment(and(early(treatment(initiation.
2. Description
3. Lessons Learned
4. CONCLUSION
P S Ih e a lth y liv e s@ P S Iim p a c t p o p u la t io n !se
rv ic e s ! in te rn a t io n a l
•
Drop!In!Centers:(Safe(community(hubs(which(are(confidential(and(found(in(FSW(concentrated(“hot$spots”.
Community)HIV)Care)and)Treatment)for)Female)Sex)Workers)in)Ethiopia:)Successful)Service)Provision)through)Drop)in)CentersS"Ejigu,"E"Workalemahu,"I"lemma,"G"Mamo"
MULU$Program$Objective:"To"improve"linkage"to"treatment,"retention"and"viral"suppression"among&FSW&living&with&HIV&
17299
28030
573 1282510 1232133 11830
5 00 0
1 00 00
1 50 00
2 00 00
2 50 00
3 00 00
Y 4#( O ct# 20 15 ,S ep t# 20 16 ) Y 5#( O ct# 20 16 ,D e c#2 01
7 )
#"FS
W
D IC $b a s e d $A R T $s e r v ic e $! m a k in g 'a 'd if fe
re n c e '
T es te d
P os iti veid en ti fie dli nk ed
A RT $in it ia tio n
DIC!Based&ART
89% 26% 5% 96% 96%3%
Facility!Based&ART
!
Retention'and'Viral'suppression'improved:'92%'of'patients'with'VL'results'(281/305)'are'virally'suppressed'and'12'month'
retention'is'also%92%.
8%
9 2%
3rd$90$!among&305&VL&result&92%&are&suppressed&
V L# # 10 0 0# co pi es /m l
3. Lessons Learned conti…..
• HIV services at FSW friendly DICs improves:
o HIV case findingo Linkage rates
o Treatment initiation
o viral suppression• Service tailored to key population which is
confidential, convenient working hour, low waiting time,
confidential, and FSW!
friendly services such as those offered in the DICs are a
successful strategy for implementing community ART service
provision.
• DIC are well positioned to realize the vision od 90!90!90
goals.
• Outcomes significantly better than referrals to public sector
alone.
5. Next steps•
Scale&of&DIC&to&national&program&for&the&epidemic&control.&&
•
Re!packing(the(community(ART$service'with'meaningful*beneficiary*engagement.(
•
Holistic(service(including(family(members((children(and(husband).
•
Strengthen(involvement(of(PLHIV(associations(and(CSO(in(adherence(support.(
•
Include(capacity(building(component(mainly(economic(strengthening(activity.
• Standardize*community*service*package.
Fig.%1.%Mekelle Drop
in#Center#located#at#high#FSW#concentrated#hot#spot#
