With the scale up of Antiretroviral therapy (ART), most district health facilities in Zambia began experiencing increased congestion. Patients face significant challenges to retention including transportation costs, time away from work, long clinic waiting times, and competing life priorities with greater need to develop strategies to cater for the different needs and situations of ART patients.
In July 2017, CIDRZ through its Pharmaceutical Services Department with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership of U.S Centers for Disease Control and Prevention (CDC) developed differentiated service delivery models (DSD) of care among others, namely Health Post and Fast Track (Static) for ART dispensation.
The models which are in line with WHO and 2016 Ministry of Health (MoH) ‘Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection are being implemented in 16 main facilities ,21 Health posts and 7 static sites with a total of 14, 376 patients enrolled between October 2017 and February 2018.
The objectives of the models are to decongest main facilities by aligning bi-annual medicine refills with clinical visits, reduce the cost and distance a patient is required to travel to pick up drugs and reduce pharmacy waiting time for patients at the facility. The models target stable patients with CD4 >=200/µl and viral load suppression of <1000 copies/ml.
Three months’ supply of drugs for patients on the Health Post model are delivered weekly to health posts closer to their homes to ensure a steady and uninterrupted supply of drugs. Drugs for patients on the Fast Track model are delivered to a separate dispensing location within the facility where stable patients pick up their three months’ supply of drugs.
Matero Reference clinic is among the facilities where the two models have been highly accepted by both patients and the facility staff. Enrollment at the health facility started on 26th October 2017 and to date 6,014 stable patients have been enrolled into both Health Post and Fast Track Models.
Grace Pumulo, a beneficiary of the Fast Track model is elated with the model;
“I have been on ART since 2007.In all these years before enrolment on the model, I spent long hours queuing up to receive ART services such as clinician appointments, laboratory tests and even getting drugs. With this model, I just walk in here and within a short time, I am attended to and go back home to do other things”.
Pharmacy Technologist at Matero Reference Clinic, Tinda Mbewe shared her experience;
“Before the introduction of the DSD program, we used to attend to 300 stable and unstable patients in a day. With two pharmacists working on that number of patients’ files and dispensing drugs, one would only imagine the amount of stress that comes with it. However, after the introduction of Fast Track, there is reduced workload as we only see 100 patients a day”.
Sabrina Sakala, a Treatment Supporter at Matero Reference clinic said;
“Matero Ref alone has enrolled 6,014 stable patients on Fast Track. On average, we attend to 150 patients per day with each patient spending about 10 minutes. What this means for the client is that they spend less time here at the facility and are able to go back to attend to their daily activities. Some patients say that the model guarantees them more confidentiality as they do not have to queue up just to receive their drugs.”
Another Treatment Supporter, Estella Ngowani had this to say;
“What we are now experiencing are overwhelming requests from patients once we go to the main pharmacy at Matero to sensitize them about the program. This simply shows that patients have understood the aims differentiated service delivery models want to achieve”.
Helen Bwalya Mulenga, Head of Pharmacy at CIDRZ explains;
“I am excited to lead and drive the team in the implementation of Differentiated Service Delivery for ART, these models will provide improved patient adherence and retention and enable us to positively contribute to decongesting ART clinics, reducing patient wait times and reducing patient costs by offering them an opportunity to collect drugs near their homes”.