Haiti Project Briefs
The main objectives of the TIDE Haiti project are to:
- Embrace a “patient-centered approach” to health care
- Engage and strengthen People Living with HIV associations
- Address patient retention issues
- Address stigma and discrimination
- Strengthen a differentiated community service delivery strategy
TIDE- Integrated Patient-Centered Community-based Outreach System (IPCOS)
The overarching aim of the TIDE-IPCOS is to establish an effective community-based and managed outreach system built around PEPFAR-supported clinical facilities. It employs enhanced strategic information systems with long-term, longitudinal client data to implement a patient-centered approach that extends facility-based and managed services to the community level. It also enables an ongoing capacity of providers and stakeholders to account for the care status of any patient enrolled in the national HIV program at any given moment.
Working with SOLUTIONS Haiti, TIDE-IPCOS has expanded the reach and functionality of national Health Management Information Systems and Databases. It is nearing the point at which the Haiti national HIV program can boast of an integrated nation-wide system capable of serving any client in the network at any care delivery point – with real time access to pertinent client data. TIDE-IPCOS is continually enhancing this system with updated data verified through field outreach activities – including geolocation and vital status data – and using this to drive precision programming by TIDE and other implementing partners. This system has proven very effective at reaching and engaging clients who have long been lost to follow-up and care at treatment facilities.
TIDE-IPCOS also directly deploys Community Health workers (CHWs) within high patient population communities, equips them with devices linked directly to the national database, and uses them to track, engage, and support clients in their homes and communities. This non-facility-based approach augments and supports care and treatment services provided at facilities with extensive bi-directional referrals between the two systems.
This community-based outreach system has significantly expanded patient choice, increased the pool of patient primary contacts and advocates, and improved demand for the various Differentiated Service Delivery Models being implemented in Haiti.
TIDE-IPCOS works with TIDE-PEARS to use Georgetown University’s Local Innovations Scaled Through Enterprise Networks (LISTEN), with its embedded Human-Centered Design (HCD) methodology to inquire about client/patient factors that drive behavior and obtain beneficiary perspectives on services and approaches that will best address their needs. Similar methodologies and approaches are used to engage healthcare providers as well. Using data and information obtained from these engagements, communities of practice are established that meet regularly and jointly review data to identify common or unique challenges and formulate solutions from the ground up with beneficiaries and providers who are jointly contributing. LISTEN enables TIDE to increasingly promote a patient-centered approach to care and allows the more effective use of community health workers to address issues that impact service uptake and retention in care.
TIDE- Peer Engagement for Assured Retention and Support (PEARS)
The overarching aim of PEARS is to design and implement a peer-led project for tracking and returning lost-to-follow-up HIV clients to care, enhance client retention in care and facilitate access to various differentiated HIV service delivery models, and implement strategies to improve the quality of stigma-free HIV service delivery at care and treatment facilities. Working with Associations of People Living with HIV (PLHIVA), the project increases peer participation in adherence support and retention at patient levels and in conjunction with the larger health system.
The project was designed to take advantage of Haiti’s pool of PLHIV on treatment as integral participants in on-going adherence, return to care, and retention interventions for their fellow PLHIV. In many instances, peers are more knowledgeable about the actual whereabouts of ‘missing’ clients than heath care workers and are capable partners in the provision of ongoing support that leads to high-quality outcomes. This includes long-term adherence to, and retention on, care and treatment. Working with PLHIV Associations, TIDE engages PLHIV peers through three main activity tasks:
- As tracking agents seeking and facilitating the return of patients that are lost to follow up to care
- As patient care navigators working within healthcare facilities to support and guide patients (especially those who have been out of care for a significant amount of time) through HIV care, including the many approved Differentiated Service Delivery models
- As part of peer-led community adherence groups that provide essential services (including drug distribution) to fellow PLHIV within the community
Using ongoing program data, TIDE distributes peer assignments across locations and patients as necessary. It maintains proximity of peers with PLHIV in their communities and equips them with the necessary technology to geo-track and geo-tag known and new patient locations and update these records within the national HIV treatment database as necessary.
TIDE- Drug Dispensing Points (DDP)
The overarching aim of TIDE-Drug Dispensing Points (DDP) is to establish and manage community-based dispensing points in selected high-burden areas and areas where patients will benefit from easier access to medication and enhanced ability to stay on treatment. This strategy will address patient difficulties accessing clinical facilities for drug refill by situating these dispensation points at strategically located settings widely accepted and attended by beneficiaries (such as local pharmacies, People Living with HIV association offices, and houses of worship), and provide more convenient pick-up points for patients on differentiated service delivery models such as multi-month scripting.
Dispensing Points to Areas with High Patient Populations and High Rates of LTFU:
- Implement DDPs in departments and locations across the country with continued focus on patient centered services
- Serve high-patient population areas, especially areas most vulnerable to service disruption, where a significant proportion of patients are on multi-month scripting, and where there are high numbers of priority populations
- Prioritize ease of patient engagement, confidentiality, and minimal disruptions to other services at the site, and proper data management.
- Integrate dispensing for HIV and non-HIV patients from the same location to avoid stigma of any sort
Types of DDPs:
- Community-based delivery
- Fixed location delivery managed by community health workers or lay personnel
- Fixed location delivery managed by pharmacy technicians
- Drug dispensation and pick-up at a fully-fledged pharmacy managed by pharmacists
Implementation of GU LISTEN:
TIDE-DDP uses Georgetown University’s LISTEN/HCD methodology to inquire about client/patient perspectives, understand drivers of behavior, and obtain patient perspectives on those services and approaches that will best address their needs and doubts while still promoting retention in care. LISTEN facilitates communities of practice set up to meet regularly to jointly review data and identify common or unique challenges and solutions using the grounds up approach.