USAID STRENGTHENING THE CARE CONTINUUM PROJECT (The Care Continuum) Experience with same – Day HIV treatment initiation among female sex workers 10 May, 2018

Authors: Affiliation: E.Nartey1, E. Appiah1, M. Addison-Fynn1, E. Ninson3, H. Nagai 2, Y. Abdul Rahman 2, E. Adiibokah3, 1 Hope for All Foundation (HOFA) 2 JSI Research & Training Institute, Inc. 3 Population Council

Outline Background Description Same-day ART initiation Merits Results Lessons Learnt Conclusion/Next Steps

Background door-to-door testing peer-led helpline counseling Providing comprehensive services for Key Populations (KP) remains crucial to the achievement of the 90-90-90 fast track targets to end the AIDS epidemic. Several strategies and interventions have been introduced to strategically target higher risk KP to achieve the fast track targets. Some of these strategies are: door-to-door testing peer-led helpline counseling social network testing One of the key challenges however has been enrolling KP positives into ART treatment.

Description: Same-day ART initiation HOFA introduced a strategy called ‘same-day ART initiation’ under the USAID Strengthening the Care Continuum Project to help address this challenge. The strategy is in line with the new Ghana Health Service guidelines and the “Treat All” policy. Same-day initiation involves starting HIV positive individuals on ART immediately or the same day their test results are confirmed. This strategy commences with thorough counseling by experienced counselors after which ART is administered

The three-week long counseling period, previously done for HIV positive individuals before ART initiation is made concise to ease initiation. Laboratory investigations are done alongside the initiation. Clients do not have to wait for all investigation results before commencing treatment. Description: Merits

Description: Merits Persistent challenges, such as lack of funds to conduct investigations and increased waiting time before enrolment, are eliminated. Same day initiation increases the confidence KP positives have in the Health Services as they receive prompt services.

Results FISCAL YEAR POSITIVES ENROLLED PERCENTAGE 2017 116 92 79.3% 2018 (QUARTER1) 38 100%

Lessons learned Same-day initiation will help eliminate the persistent challenges while significantly increasing the numbers enrolled on treatment. Advocacy and engagement of health care providers make same day initiation easier. In line with the “treat all” policy, same day initiation is possible to achieve 90-90-90 targets.

Conclusion/Next steps Same day initiation has proven to be very important in ART enrollment. HOFA is determined to scale up, intensify advocacy at all fronts on same-day initiation. HOFA will continue to support comprehensive case management to improve adherence to achieve treatment outcomes.

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