TY - JOUR
T1 - Gaps and opportunities in hiv service delivery in high volume hiv care centers in liberia
T2 - Lessons from the field
AU - Adeiza, Mukhtar A.
AU - Wachekwa, Ian
AU - Nuta, Cecilia
AU - Donato, Sean
AU - Koomson, Freda
AU - Whitney, Jane
AU - Plyler, Chelsea
AU - Kerr, Lila
AU - Sackey, Godsway
AU - Dunbar, Elizabeth
AU - Talbert-Slagle, Kristina
AU - Klar, Robin
AU - Marsh, Regan H.
AU - Caldwell, Samretta
AU - Toomey, Julia
AU - Ogbuagu, Onyema
N1 - Funding Information:
In the last five years, overall domestic healthcare spending including for HIV services in Liberia has dropped [22]. Funding for HIV related activities is largely supported through external sources including the Global fund for AIDS, tuberculosis (TB) and malaria (GFATM), The US Presidents Emergency Fund for AIDS Relief (PEPFAR) and other international organizations through the MoH. In 2012, 99.2% of the total funds for HIV services were from external sources with domestic spending accounting for only 0.8% (with public funds accounted for 0.6% of the total funds while private funds accounted for 0.2%) [7]. Domestic funding for HIV services further dropped to 0.1% in 2015, a dismal amount compared to an 18% average for other low-income countries in the
Funding Information:
RRHS Liberia is conducted with support from the U.S. President’s Emergency Plan for AIDS Relief through the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), as part of an award totaling $9.5 million.
Funding Information:
In 2016, WHO recommended providing three to six months multi-month dosing (MMD) for stable clients to reduce the frequency of clinic visits and ART refills [25]. This approach to differentiated service delivery (DSD) was widely adopted across facilities during the 2020 COVID-19 lockdown [33]. It is supported by major funding agencies including PEPFAR, International AIDS Society (IAS) and the GFATM and has been incorporated into the national guidelines [33]. Pharmacy delivery [55] needs to be scaled up to expand access in a client centered approach that simplifies and adapts HIV services across the cascade in ways that both serve the needs of subpopulations of PLWH better and reduce unnecessary burdens on the health system [54].
Publisher Copyright:
© 2021 The Author(s).
PY - 2021
Y1 - 2021
N2 - Background: Human Immunodeficiency Virus (HIV) infection continues to have a profound humanitarian and public health impact in western and central Africa, a region that risks being left behind in the global response to ending the AIDS epidemic. In Liberia, where the health system is being rebuilt following protracted civil wars and an Ebola virus disease outbreak, the Resilient and Responsive Health System (RRHS) is assisting with quality HIV services delivery through support from PEPFAR and HRSA but gaps remain across the cascade of care from diagnosis to viral load suppression. Objective: To highlight gaps in HIV service delivery in Liberia, identify opportunities and offer recommendations for improving the quality of service delivery. Methods: A narrative review of relevant literature was conducted following a search of all local and online databases known to the authors. Findings: Antiretroviral therapy (ART) has transformed the HIV response in Liberia by averting deaths, improving quality of life, and preventing new HIV infections but critical gaps remain. These include weak HIV prevention and testing strategies; suboptimal ART initiation and retention in care; low viral load testing volumes, commodity supply chain disruptions and a HIV workforce built on non-physician healthcare workers. In the context of the prevailing socioeconomic, heath system and programmatic challenges, these will impact achievement of the UNAIDS targets of 95-95-95 by 2030 and ending the epidemic. Conclusion: Combination prevention approaches are necessary to reach the most at risk populations, while a robust health workforce operating through facilities and communities will be needed to reach people with undiagnosed HIV earlier to provide efficient and effective services to ensure that people know their HIV status, receive and sustain ART to achieve viral suppression to maintain a long and healthy life within the framework of overall health system strengthening, achieving universal health coverage and the sustainable development goal.
AB - Background: Human Immunodeficiency Virus (HIV) infection continues to have a profound humanitarian and public health impact in western and central Africa, a region that risks being left behind in the global response to ending the AIDS epidemic. In Liberia, where the health system is being rebuilt following protracted civil wars and an Ebola virus disease outbreak, the Resilient and Responsive Health System (RRHS) is assisting with quality HIV services delivery through support from PEPFAR and HRSA but gaps remain across the cascade of care from diagnosis to viral load suppression. Objective: To highlight gaps in HIV service delivery in Liberia, identify opportunities and offer recommendations for improving the quality of service delivery. Methods: A narrative review of relevant literature was conducted following a search of all local and online databases known to the authors. Findings: Antiretroviral therapy (ART) has transformed the HIV response in Liberia by averting deaths, improving quality of life, and preventing new HIV infections but critical gaps remain. These include weak HIV prevention and testing strategies; suboptimal ART initiation and retention in care; low viral load testing volumes, commodity supply chain disruptions and a HIV workforce built on non-physician healthcare workers. In the context of the prevailing socioeconomic, heath system and programmatic challenges, these will impact achievement of the UNAIDS targets of 95-95-95 by 2030 and ending the epidemic. Conclusion: Combination prevention approaches are necessary to reach the most at risk populations, while a robust health workforce operating through facilities and communities will be needed to reach people with undiagnosed HIV earlier to provide efficient and effective services to ensure that people know their HIV status, receive and sustain ART to achieve viral suppression to maintain a long and healthy life within the framework of overall health system strengthening, achieving universal health coverage and the sustainable development goal.
UR - http://www.scopus.com/inward/record.url?scp=85120169724&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120169724&partnerID=8YFLogxK
U2 - 10.5334/aogh.3246
DO - 10.5334/aogh.3246
M3 - Article
C2 - 34900615
AN - SCOPUS:85120169724
VL - 87
JO - Mount Sinai Journal of Medicine
JF - Mount Sinai Journal of Medicine
SN - 0027-2507
IS - 1
M1 - 115
ER -