Provision of antiretroviral therapy during flexible clinic hours and an enhanced package of services increases treatment initiation in Dominican Republic

BACKGROUND: Since October 2019, USAID-funded HIV System Strengthening (HS3) project, implemented by FHI 360, has supported HIV prevention and treatment services to focus clients (FCs) ' Haitian migrants and their descendants' at the community and facility level in Dominican Republic. FCs are mobilized through their peer network, offered HIV testing and navigated to 18 facilities in six provinces, where they can access antiretroviral therapy (ART).
DESCRIPTION: From April 2020, HS3 project began offering flexible ART clinic hours and an enhanced ART package to HIV-positive FCs to increase ART initiation. The intervention targeted newly diagnosed FCs as well as individuals known HIV positive who were lost and returned to treatment. Twelve clinics initiated ART after working hours and at community hot spots that were easily accessible by the FCs and where HIV testing and treatment services were integrated. The enhanced ART package given at ART initiation included: six months of a pre-paid SIM card, airtime voucher, and food vouchers; 12 months transportation allowance; voucher to cover baseline investigations. The items included in the package were based on the outcome of consultations with HIV-positive FCs. We present trends from October 2019 to December 2020 showing the effect of the intervention on ART initiation.
LESSONS LEARNED: Between October 2019 and December 2020, the project identified 2,073 HIV-positive FCs and started 1,512 (73%) on treatment. Among 705 HIV-positive FCs identified during six months pre-intervention, 44% (307) were initiated on ART, compared to 85% (485/568) during the six months post-intervention (p < .00001). Furthermore, when comparing the second quarter of the post-intervention period (July'September 2020) to the following quarter (October'December 2020), ART initiation was sustained at a high rate (Table 1).

Time period	HIV positive	Initiated on ART	ART initiation rate
October-December 2019	321	115	36%
January-March 2020	384	192	50%
Pre-intervention (October 2019-March 2020)	705	307	44%
April-June 2020	185	143	77%
July-September 2020	383	342	89%
Post-intervention (April-September 2020)	568	485	85%
October-December 2020	800	720	90%
October 2019-December 2020 (Total)	2,073	1,512	73%

CONCLUSIONS: Providing ART during flexible hours and venues, together with an enhanced ART package was successful in increasing and sustaining high treatment initiation among FCs over a period of nine months following rollout.