Breaking Barriers and Building Bridges to the Continuum of Care

The theme for the 22nd International AIDS Conference (AIDS 2018), Breaking Barriers Building Bridges, perfectly encapsulates the transformation I’ve witnessed while working on the JSI-implemented USAID Strengthening the Care Continuum Project. The Project is dedicated to reaching members of key populations (KPs) or communities who have a higher risk for HIV infection and transmission: men who have sex with men (MSM), female sex workers (FSWs), transgender men, and their partners.

At AIDS 2018, I discussed the Care Continuum’s work, specifically our success in enrolling and retaining key populations in care.

This year’s conference focused on a rights-based approach to reaching KPs, an aspect that is woven into the design and implementation of the Project. Our mission is to improve KP access to, and use of, HIV services while working toward reducing stigma and discrimination in health settings. To do so, we partner with the Government of Ghana and ten civil society organizations (CSOs) to build capacity related to testing and scaling effective, innovative ways of reaching KPs.

When the Project first started, we found that there was a lack of clear, well-structured case management systems; the testing modalities in use often didn’t effectively reach those who were “hidden;” and clients were frequently lost or didn’t enroll in care after being tested. We’ve worked hard to remedy these issues and support our partners in more effectively engaging and treating KPs.

Now, halfway through the Project’s implementation period, we’ve seen improvements in all of our CSO partner’s work. There are now seven case managers and 103 peer educators in the field who the Project has trained to more effectively engage with KPs. There are also health workers in government-owned facilities who have gone through KP sensitivity training to reduce health facility stigma toward KPs.

Additionally, partners have adopted a differentiated model of testing, with strategies including health facility referral testing, mobile outreach testing, and HelpLine counseling. As a result, more than 6,392 new individuals were tested for HIV during the last quarter (April to June 2018), 12 percent of whom were HIV positive.

Finally, because of the Care Continuum’s support, it now takes less time to put clients who test positive on ART. For example, during the second quarter of 2017, it took nearly one and a half months to have someone enrolled—it now takes an average of a week and in some facilities, just one day. Data suggests that we’ve also had success in keeping the momentum going. As of June 2018, current information on viral load suppression suggests that FSW and MSM are 51 percent and 64 percent virally suppressed, respectively.

While our work is far from over, the individual transformations we’ve witnessed truly speak to the barriers the KPs we work with have overcome and the bridges we’ve helped to build between KPs, communities, and facilities. As one health worker who received training from the Project said, “After having conversations with key populations, you realize, besides their sexual orientation or anything else, they are just like you and me, and they thank you, and it makes you feel happy.”

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