Achieving HIV Epidemic Control and Improving Maternal Healthcare Services with Community-Based HIV Service Delivery in Zambia: Mixed-Methods Assessment of the SMACHT Project

• Published in: AIDS and behavior Vol. 27; no. 11; pp. 3571 - 3583
• Main Authors: Claassen, Cassidy W., Kafunda, Ina, Mwango, Linah, Shiyanda, Steven, Stoebenau, Kirsten, Gekanju-Toeque, Mona, Lindsay, Brianna, Adebayo, Olufunso, Sinjani, Msangwa, Kaayunga, Callistus, wa Banza, Pappy Kakonda, Mweebo, Keith, Kancheya, Nzali, Musokotwane, Kebby, Mwila, Annie, Monze, Newman, Nichols, Brooke E., Blanco, Natalia, Lavoie, Marie-Claude C., Watson, Douglas C., Hachaambwa, Lottie, Sheneberger, Robb
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2023; Springer Nature B.V
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Antiretroviral therapy; Clients; Community; Community health care; Community Health Services - organization & administration; Community Health Workers; Data analysis; Delivery of Health Care - organization & administration; Disease control; Disease management; Disease transmission; Epidemics; Epidemics - prevention & control; Female; Health care; Health care facilities; Health Psychology; Health services; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Testing; Human immunodeficiency virus; Humans; Infectious Disease Transmission, Vertical - prevention & control; Infectious Diseases; Maternal Health Services - organization & administration; Medical personnel; Medicine; Medicine & Public Health; Mixed methods research; Mothers; Original Paper; Perinatal care; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - prevention & control; Public Health; Qualitative analysis; Qualitative Research; Young Adult; Zambia - epidemiology; Zambia; PMTCT; HIV; PBFW; Sub-Saharan Africa; Test & start; Differentiated service delivery
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-023-04071-7

Novel community-based approaches are needed to achieve and sustain HIV epidemic control in Zambia. Under the Stop Mother and Child HIV Transmission (SMACHT) project, the Community HIV Epidemic Control (CHEC) differentiated service delivery model used community health workers to support HIV testing, ART linkage, viral suppression, and prevention of mother-to-child transmission (MTCT). A multi-methods assessment included programmatic data analysis from April 2015 to September 2020, and qualitative interviews from February to March 2020. CHEC provided HIV testing services to 1,379,387 clients; 46,138 were newly identified as HIV-positive (3.3% yield), with 41,366 (90%) linked to ART. By 2020, 91% (60,694/66,841) of clients on ART were virally suppressed. Qualitatively, healthcare workers and clients benefitted from CHEC, with provision of confidential services, health facility decongestion, and increased HIV care uptake and retention. Community-based models can increase uptake of HIV testing and linkage to care, and help achieve epidemic control and elimination of MTCT.