Linkage to care of HIV positive clients in a community based HIV counselling and testing programme: A success story of non-governmental organisations in a South African district

Abstract

IntroductionAlthough current data projects South Africa potentially meeting the UN target to test 90% of all people living with HIV by 2020, linking them to HIV care remains a big challenge. In an effort to increase linkage to care (LTC) of HIV positive clients an innovative collaborative intervention between two non-governmental organisations was developed and implemented between 2016 and 2017. This paper investigated the outcome of this collaborative intervention.MethodsWe used a mixed methods approach to assess the outcome of the innovative relationship. This was done by analysing routine programmatic quantitative data on LTC between 2015 and 2017 and qualitatively interviewing five programme managers, four programme implementers and five HIV positive clients on their perceived success/failure factors. Qualitative data were analysed using thematic content analysis while LTC rates were descriptively analysed. Two consultative meetings presented draft findings to programme managers (n = 7) and implementers (n = 10) for feedback, results verification and confirmation.ResultsIn 2015 cumulative LTC rate was 27% and it rose to 85% two years post-intervention in 2017. Six themes emerged as success factors at the health system and structural levels and these include: provision of client escort services, health facility human resource capacity strengthening, inter and intra-organisational teamwork, onsite LTC, facilitated and expedited jumping of queues and shifting administrative tasks to non-clinical staff to protect nurses’ time on ART initiation. These measures in turn ensured increased, affordable and swift ART initiation of clients while strengthening client support.ConclusionsWe concluded that multi-faceted interventions that target both health system challenges including staff shortages, efficiencies, and extended facility opening times, and structural inadequacies, including client time and resource limitations due to poverty or nature of jobs, can help to increase LTC.

Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities—Nigeria, 2016-2017

“…The approach assisted parents/guardians to quickly navigate the ART clinic and obtain care for their children. The excellent linkage rate observed in our study was comparable to those reported for a South African ART program that utilized escort services to facilitate linkage to treatment among HIV positive adults, and scale-up of this approach in the Nigeria HIV program will ensure that identified HIV-positive children are offered ART [25].…”

Comparison of community-based HIV counselling and testing (CBCT) through index client tracing and other modalities: Outcomes in 13 South African high HIV prevalence districts by gender and age

“…Several other factors contributed and these include relationship management between the CBCT programme and health facilities, provision of client escort services to facilities, addressing barriers at the health facility level including task shifting of administrative duties to non-clinical staff. Some of the successes in linkage to care and treatment in this programme were reported before[37].…”

A Cascade of Interventions to Promote Adherence to Antiretroviral Therapy in African Countries

“…In South Africa, contracting with a non-governmental organisation to provide escorted transport from home to referral facility increased ART enrolment from 27% at baseline to 85% post intervention [22]. In Nigeria, the Community Treatment Initiative started PLHIV (who had previously refused ART) on treatment in the community.…”