Lillian Mworeko, International Community of Women living with HIV Eastern Africa (ICWEA), Uganda, writes:
DSD models should be designed and delivered around the choices, options and priorities of service recipients. Putting the service recipient at the centre means making sure that they meaningfully participate in decision making about what, when, where and how they access services.
Furthermore, it means acknowledging that the needs and priorities of people living with HIV change over time and may require transition to a different model. The changes that may require a service delivery transition can be related to ageing, pregnancy, clinical stability and other personal circumstances.
DSD models that are truly centred around the needs of people living with HIV must not only focus on processes, procedures and protocols, but also pay attention to facilitating effective transitions or moves between models. Too often, services do not appropriately respond to the heterogeneity of people living with HIV and the dynamic nature of their lifelong antiretroviral therapy (ART) journey.
For example, a pregnant woman’s priorities and needs may change over time. In my country, many pregnant women will travel to their up-country homes, close to their own mothers, to deliver their babies and receive support. Before travelling, the expecting mother may need to get ART refills for a long period, even up to a year, so that if she delays coming back to the city, her treatment will be uninterrupted. These circumstances require a system that is flexible and supportive, provides space for dialogue with clients and invests in feedback mechanisms.
A model that works well for an individual today may not work tomorrow. In such cases, we need the system to listen to the individual and support the person to access the services they need and that work best for them. Such an approach to service delivery will support long-term treatment adherence and retention in care.
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To support adolescents who are ageing into adulthood, the Eswatini Ministry of Health included “transitioning clubs” in their 2022 guideline update. Transitioning clubs are for adolescents and young adults, aged 16-24 years, and have the same ART refill and clinical review frequency as clubs for adults.
We spoke with Florence Anabwani, Baylor Foundation Eswatini, Eswatini, about the Adolescent Transition Program supported by her organization.
Florence, what is the overarching goal of the Adolescent Transition Program?
The objective of the programme is to ensure a seamless transition from paediatric to adult healthcare services for adolescents living with HIV. This is crucial because as adolescents grow older, their healthcare needs evolve and they must be prepared to manage their HIV independently. The successful implementation of an Adolescent Transition Program includes a multidisciplinary approach that addresses medical, psychosocial and educational needs of these clients.
How do you identify clients for the transition programme and assess their service needs?
With our monitoring and evaluation team, we identify clients who are approaching the age where a transition to adult services will be necessary. These clients are then assessed to determine their readiness for transition, taking into account their cognitive maturity, full disclosure, emotional stability, adherence to medications, self-management skills, support systems and understanding of their diagnosis and the necessary management strategies. Further evaluations are done during teen club meetings and Camp Sibancobi.
How does the programme facilitate the transition to adult services?
Once the multidisciplinary team feels that the adolescent or young adult is ready, the client selects a healthcare facility of their preference and the team facilitates linkage and transition to adult services. This involves a telephonic handover call during which the Baylor Clinic team introduces the client to the adult team and discusses their history and needs. We also mobilize resources to provide ongoing support or follow up to ensure that the transition is successful.
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