Improving viral load testing and suppression through implementation of differentiated service delivery models during COVID-19 in five counties in Kenya


BACKGROUND: As COVID-19 continued to spread, HIV programs in Kenya are experiencing disruptions. Safeguarding the gains of the national HIV response requires accelerating differentiated service delivery (DSD) interventions while minimizing potential exposure of health care workers and patients to COVID-19. The USAID-funded Afya Nyota ya Bonde (ANyB) project implemented by FHI 360 in five counties in Kenya adapted and scaled-up DSD interventions to improve viral load (VL) testing uptake and suppression.
DESCRIPTION: Beginning January 1, 2020, the following models were implemented to ensure treatment adherence and improve viral suppression, and to improve VL coverage: VL sample collection aligned with clinical and antiretroviral therapy (ART) refill appointments ; implementation of papa-mama clinics for family-oriented services; operation triple-zero clinics targeting adolescents and young women; community ART refill groups established; and weekly tracking of missed opportunities for VL. The project also implemented a hub-and-spoke model to strengthen VL sample collection and transportation in 172 ART sites using 20 laboratory hubs. Motorcycle riders picked and transported samples to reduce turnaround time.
LESSONS LEARNED: From a baseline VL testing coverage of 84% and suppression rate of 89% in December 2019, both increased to 93% by September 2020 among 62,195 eligible clients. The greatest increase in site-level VL testing coverage was among adults (20+ years), with an average 13% increase per site from 80% to 93% (p=0.012) compared to adolescents aged 10'19 years with an increasefrom 88% to 95% (p-value=0.957), and children <10 years (82% to 92%; p=0.371). Site-level viral suppression increased from 75% to 81% for adolescents, from 72% to 76% for pediatric patients, and from 91% to 94% among adults and this was statistically significant for all population groups (p<0.001).
CONCLUSIONS: ANyB's implementation of DSD models targeting different population groups, along with strengthening its referral system through the hub-and-spoke model, led to improvements in VL testing coverage and suppression despite challenges posed by COVID-19. Scale-up of these models should continue during and beyond COVID-19 to ensure high VL testing coverage and suppression rates.