Dorlim Moiana Uetela, Instituto Nacional de Saúde, Mozambique writes:
The satellite session, “DSD model transitions: Supporting the evolving care needs of people living with HIV”, highlighted person-centredness as the governing DSD principle. To adhere to this principle, a dynamic healthcare system that acknowledges that health needs evolve and provides flexible responses is required.
Thematically, the oral abstract sessions on DSD were dominated by pre-exposure prophylaxis (PrEP), with abstracts focusing on the feasibility and acceptability of innovative strategies (South Africa, Uganda, Vietnam, Zimbabwe) and on promising implementation results. In the oral abstract session, “Show me the money: The cost of epidemic control”, the eight DSD models for HIV treatment implemented in Mozambique were found to be more effective in retaining clients on ART and less expensive to the health system and clients than the standard of care.
In addition to enabling effective transitions, integrating services, and investing in new technologies and the best treatment delivery and prevention strategies, the key take-home message of IAS 2023 is to continue keeping the client at the centre of the HIV response.
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We spoke with Danvic Rosadiño, Head of Programs and Innovations at LoveYourself, a community-based organization providing safe spaces to communities and services related to sexual health, including HIV, trans health and mental health, in the Philippines.
Danvic, please can you describe the context in which LoveYourself operates?
We have 13 community centres in major cities in the Philippines. We are experiencing a low-prevalence, high-incidence HIV epidemic. The number of people living with HIV is still less than 1% of the population, but acquisitions are increasing rapidly among key populations: gay, bisexual, and other men who have sex with men, trans women, people who inject drugs, sex workers, and others. We are diagnosing around 50 people per day. Nearly half of the new acquisitions are in the 15–24-year age group. If we don’t do something differently, the number of people living with HIV in the Philippines is expected to increase to 401,700 by 2030.
What was the gap or challenge that led to the development of e-PrEPPY?
PrEP has reached more than 10,000 individuals in the Philippines since it was introduced in 2017. But with the type of epidemic we are experiencing, we need to reach more people. Differentiated models of offering PrEP are urgently needed. There are challenges to service access, such as ease of attending a health facility. This is especially the case in Metro Manila: traffic is always heavy and clients may be working at night and are confronted with external stigma emphasized by the conservative culture, which is highly religious and views sex as taboo.
In a programme called e-PrEPPY, we introduced an all-virtual, community-led PrEP service for gay, bisexual and other men who have sex with men using a demedicalized approach.
How does your all-virtual PrEP programme work?
Clients who report as HIV negative in the online unassisted HIV self-testing programme of LoveYourself (SelfCare) are asked for their interest in PrEP. A blood-based self-test kit, with instructions, is sent to their address. Clients can choose between delivery to an address or pick up at logistics partners across the Philippines. They do not need to go to a health facility.
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