Increasing HIV case identification and linkage to antiretroviral therapy through nutrition screening: Lessons learned from the Cote d'Ivoire nutrition and community-facility linkages activity
Background: Increasing
HIV case identification and linkage to antiretroviral therapy through nutrition
screening: Lessons learned from the Cote d''Ivoire Nutrition and Community-Facility
Linkages Activity.
Description: FANTA led the establishment of partnerships between service providers at
11 health facilities, and 8 social centers and 14 community-based organizations
(CBOs), which provide services to orphans and vulnerable children and their
caregivers in 8 districts around Abidjan. Health workers screened clients seeking
psychosocial support at social centers and CBOs for nutritional status using
mid-upper arm circumference. Individuals identified with moderate- or severe-acute
malnutrition were referred to a health facility, Nutrition focal points were assigned
at each location, registries and forms were developed to facilitate and document
referrals between locations. HIV seropositive
clients were managed through a case management system, followed for malnutrition
treatment, and enrolled in HIV treatment and other support services. A client list, HIV patient appointment
schedules and care plans were shared among service providers who communicated to
ensure clients received services. Clients
lost to follow up were contacted by phone or home visit and counseled to
re-engage in care.
Lessons learned: Malnutrition can signal the presence of an HIV infection. Between January 2015 and December 2017, 25,000 clients
received psychosocial support at the social centers and community-based organizations, 42% of whom (10,493)
were screened for malnutrition. Among those screened, 11% (1,144) had moderate-
or severe- acute malnutrition and referred to the health facility. Of those referred,
49% (563) were tested for HIV; 63% (354) of those tested were HIV-positive. 98%
of the HIV-positive individuals were initiated on antiretroviral therapy. 116 HIV
seropositive individuals lost to follow up were re-engaged in care. The integration of NACS and HIV care delivery
and the facility and community partnerships developed through the NCFLA increased
HIV case identification and facilitated enrollment into the HIV services, including ART initiation, adherence and retention counseling.
Conclusions/Next steps: NACS services and partnerships developed through the NCFLA in
Cote d''Ivoire provided a new gateway to HIV case identification and enrollment
into the HIV treatment cascade. Integrated service delivery and context-appropriate community-facility
linkages are recommended as part of the response to end the HIV epidemic by
2030.
A. Rurangwa1,2, E. Kouassi3, D. N'Dabian3
1FHI 360, Global Health, Nutrition and Population, Washington DC, United States, 2FHI 360, Food and Nutrition Technical Assistance Project, Washington, DC, United States, 3FHI 360 Cote d'Ivoire, Food and Nutrition Technical Assistance, Abidjan, Cote D'Ivoire