Differentiated Service Delivery (DSD) model to increase access to HIV ' 1 RNA viral load testing in four states in Nigeria


BACKGROUND: Despite improvements in access to viral load (VL) testing in Nigeria, coverage remains low amongst priority sub-populations including pregnant and breastfeeding women (PBFW), children (0-9years) and adolescents and youth (10-25years). We describe the strategies implemented by RISE-Nigeria to increase access to VL testing services in 90 project-supported health facilities across four states (Akwa Ibom, Adamawa, Cross River and Niger) in Nigeria.
DESCRIPTION: RISE-Nigeria implemented a novel client-centric differentiated service delivery model for VL (DSD4VL) to increase access to VL testing services for sub-populations including PBFW, children, adolescents and youth. During the COVID-19 lockdown period, RISE secured passes from the Government to allow movement by VL Champions who provided targeted VL services at the facility and community levels between April and September 2020. VL Champions were provided with line lists of clients eligible for VL testing weekly; samples were collected at each encounter with the clients in the community, home or facility; dried blood spots for VL were collected for children, and a turnaround time (TAT) register was used to track daily samples collected and results returned to clients. We compared VLC, viral load suppression (VLS) for different sub-populations and changes in TAT of results before (Oct19 ' Mar20) and after the intervention (Apr20-Sept20).
LESSONS LEARNED: Between the two periods, overall viral load coverage (VLC) increased from 71% (24,325/35,583) to 96% (45,403/47,482), p<0.0001 and VLS from 83% (20,950/25,325) to 89% (45,403/47,482), p<0.0001. VLC increased by 20% for children, 20% for adolescents and young people, and 72% for PBFW; all of these differences were significant at p<0.0001. Similarly, VLS increased by 19% for children (p<0.001), 6% for adolescents and youth (p<0.000), and 18% for PBFW (p<0.02), 2% males >24 years (p<0.001), and 2% non-pregnant females>24 years (p<0.01). Median TAT of results reduced from 35 days at pre-intervention to 25 days post implementation.
CONCLUSIONS: The implementation of DSD4VL resulted in increases in both VLC and VLS for PBFW, children, adolescents and youth receiving services at RISE supported sites. Integrating routine VL services into existing ART DSD implementation models enabled uninterrupted, client-centered ART and VL collection services, even in the context of the COVID-19 pandemic.