Background
Kayla receiving psychological support at CEPROSH.
Kayla and Carlos are beneficiaries of the HIV Comprehensive Care Clinic at the Centro de Promoción y Solidaridad Humana, Inc. (CEPROSH) in the Puerto Plata province of the Dominican Republic. CEPROSH is a grantee of the Advancing Partners & Communities (APC) project, funded by the United States Agency for International Development, through the U.S. President’s Emergency Plan for AIDS Relief.
Kayla and Carlos enrolled at the CEPROSH HIV clinic and started antiretroviral therapy as soon as they were diagnosed with HIV. Both of them have adhered to their treatment and are in excellent physical and mental health.
Unfortunately, Kayla and Carlos are not representative of their HIV-positive peers because many people choose not to enroll in care when they find out their HIV status. This leads to a large gap in meeting the 90-90-90 treatment targets which aim to control the HIV epidemic by reducing new transmissions, lowering the viral load in those already infected, and cutting down the number of deaths and health care costs associated with HIV infection.
Intervention
Yet throughout 2016, everyone who was diagnosed with HIV at CEPROSH (117 patients) enrolled in care there. In addition, 27 patients who had an HIV test at another facility were referred to CEPROSH for care. This is because CEPROSH provides outstanding clinical care and community support to people living with HIV and to key populations at highest risk of HIV infection.
Fátima Colombo, coordinator of the CEPROSH HIV clinic, explains that counseling is key to ensuring that people recently diagnosed with HIV enroll in care.
“We guarantee confidentiality in the counseling, and offer services at the clinic where the diagnosis was made as a patient’s first option for enrollment.”
For 21-year-old Kayla, who has also suffered gender-based violence, confidentiality was a determining factor in her decision to enroll at CEPROSH’s HIV clinic, as was the information provided by the counselor on the importance of antiretroviral treatment and the holistic approach offered to help her overcome the effects of the violence she experienced.
For 36-year-old Carlos, a resident of the city of Puerto Plata, “CEPROSH’s extended hours were crucial.” He also highlighted “the humane, kind, and non-discriminatory treatment” he received.
Outcomes
CEPROSH gave Kayla and Carlos information about the services available, but more importantly, gained their trust through its compassionate staff and respectful policies. “We need to provide an environment free of stigma and discrimination, where sexual diversities are treated with respect within the framework of human rights,” Fátima asserts.
From a service delivery perspective, Fátima points to the measures that CEPROSH takes to encourage patient enrollment. After receiving a positive result, “the person goes through a medical consultation that same day, rather than having to return for another appointment.”
She explains that CEPROSH takes additional measures to avoid double-counting of people who may already be enrolled in another HIV clinic by searching for their cédula (national ID number) on the National Health Service database to ensure they are not already enrolled in care at another clinic.
Kayla and Carlos are a testament to the quality management system practiced at CEPROSH.
Lessons Learned
Patients from key populations who received an HIV test at other facilities and decided not to enroll in care after a positive diagnosis were asked about their decision. Reasons included the convenience of receiving services at another location, and avoiding being recognized by people from their own communities who might tell others about their HIV status. One transgender person said that “some clinics reject you, and they tell you they don’t have room for more people.”
Among the factors that contributed to the enrollment of all the newly diagnosed patients at CEPROSH are:
- Efficient pre- and post-test counseling
- Accompanied referral of HIV cases detected at community events to CEPROSH’s HIV clinic
- Health providers who are trained to provide emotional support
- Guarantee of confidentiality
- Extended clinic hours
- A friendly environment where people are treated with respect.
