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Clinical Service Delivery

Clinical services in resource-constrained countries face a myriad of challenges, from limited access to fragmented record keeping. Ciheb’s evidence-based approach focuses on improving access and quality of services. Fundamental to our approach is adapting HIV services to reflect client preferences and expectations across the entire continuum of care and prevention.

Our strategies include: (1) comprehensive prevention services, (2) partners and family-based index-case testing, 3) peer support networks; and 4) differentiated services. To sustain the quality of evidence-based interventions, Ciheb employs robust continuous quality improvement and helps to facilitate effective use of data for decision making within clinical and prevention programs. The approach helps to strengthen clinical care while increasing population knowledge in priority service areas.

Community engagement is critical to clinical service delivery. Advocacy and education by community stakeholders is vital to increasing uptake of services, and many chronic conditions require community- and home-based care services for successful prevention, care, and treatment outcomes. Ciheb supports and mobilizes community health workers (CHWs) to fulfill these needs.

CHWs provide community health education, conduct targeted HIV testing, and refer and link HIV-infected clients to treatment services. They also follow-up with clients and provide peer support and, when permitted, deliver antiretroviral to stable clients to ensure adherence and maintain viral suppression. CHWs help to put patients at ease through confidential face-to-face HIV counseling, while helping create smoother linkages to local health facilities.

In Zambia, for example, Ciheb’s Community HIV Epidemic Control (CHEC) differentiated service model was rolled out to more than 200 government-run clinics in Zambia and involved more than 1,000 active community health workers. The project administered over 1 million HIV tests since 2015 through index (partner and family testing) and mobile hotspot testing, linked over 90% of those testing positive to health services, and delivered antiretroviral treatment to over 2,000 stable-on-care patients. Based on CHEC’s success, the Zambian Ministry of Health adopted the model as an approved differentiated service delivery model to be implemented in Zambia. CHEC is also listed as a strategy in the 2018 Zambia Consolidated Guidelines for Treatment and Prevention of HIV.

Ciheb’s work in sub-Saharan Africa has led to more than 1.3 million people receiving HIV testing services. In Kenya and Zambia, Ciheb has helped to newly enroll more than 30,000 people on ART with an 80.6% average linkage to care. Across Kenya, Zambia, as well as Botswana, Ciheb has supported more than 530,000 people on ART with a 94.5% viral suppression rate after 12 months.

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