For the Burundi Ministry of Public Health, scaling up differentiated service delivery (DSD) models has been a priority since 2016. From April 4 to 8, 2022, Burundi welcomed ICAP’s regional CQUIN team led by Peter Preko, MBChB, MPH, CQUIN project director, to assess Burundi’s progress toward DSD scale-up. Franck Boraud, MD, regional clinical advisor, and Marline Jumbe, MA, MSc, regional M&E advisor, were also part of the visiting team. “The purpose of this visit was to gain insight into Burundi’s progress in the implementation of differentiated treatment and testing models, and to update key stakeholders and implementing partners in Burundi on upcoming CQUIN network activities to identify areas for CQUIN support,” said Dr. Preko.
During the four-day visit, the CQUIN regional team met with the office of the Minister of Health, the national STI program, Programme National de Lutte contre le Sida (PNLS), the national network of people living with HIV (RBP+), and PEPFAR country teams, among others.
Highlights – Community Adherence Group Intervention at Rushubi Hospital Achieves 99% Viral Load Suppression Rate
Community Adherence Groups (CAGs) are one of Burundi’s four priority DSD treatment models, and the country plans to continue its scale-up of CAGs in the coming year. The CQUIN team visited the Rushubi Hospital, an FHI 360-supported site located north of the capital city Bujumbura, where a robust CAG system has achieved 99 percent viral load suppression amongst its members, according to hospital data.
The CAGs at the hospital provide support to recipients of care by facilitating three multi-monthly supply of antiretroviral therapy (ART). Twelve people, including a group leader and a deputy, meet twice a month. The group leaders collect ART for the group members. Spès Bigirimana is one of the CAG leaders; he believes his service is essential. “These people would be forced to miss work to make regular hospital visits if not for the groups. With the community adherence groups, we can access medication conveniently without worrying about missing work or stigma, which can be an issue when HIV patients visit facilities.”
Beyond DSD Scale-Up – Implementing Quality DSD Services
The PNLS organized a national technical committee meeting to assess the scale-up of differentiated ART services in Burundi, using the CQUIN treatment dashboard. The CQUIN regional team noted that the country has made strides in engaging recipients of care in implementing DSD policies and procedures and that an important next step for PNLS will be to assess the quality of the services offered. Amidou Nzomwita, MD, deputy director for PNLS, requested CQUIN support in implementing DSD quality standards, including finalizing quality tools and standard operating procedures and integrating indicators into Burundi’s national health information system. “The review of field tools will make it possible for our team to sort out and define the key indicators useful to promote quality DSD services for our national context,” Dr. Nzomwita said.
Burundi participated in the recently held CQUIN Delivering Quality at Scale in DSD Programs Workshop in South Africa. Country teams, including Burundi, met to discuss DSD programs, national contexts, dashboard scores, DSD quality challenges, and discuss action plans for national DSD quality management strategies.