Virtual Community of Practice: Patients at High Risk of HIV Disease Progression

Differentiated service delivery (DSD) for patients at high risk of HIV disease progression (P@HR) has been an important theme within the CQUIN network. Network participants selected it as a priority at the CQUIN Launch Meeting, and early network activities included the development of a Call to Action for differentiated treatment models for patients with advanced disease and those who are at high risk of progression.

In July of 2017, the CQUIN workshop on DSD for P@HR convened network countries for an in-depth look at some of the challenges facing programs attempting to design and implement DSD for P@HR. During their deliberations, workshop participants identified the need for a simple screening tool to identify patients on antiretroviral therapy who are at high risk for nonadherence, missed appointments and loss to follow up. In response, the P@HR Community of Practice (CoP) was formed.

The P@HR CoP is a multi-country, virtual technical working group dedicated to collaboratively developing a simple screening tool for use by frontline health workers. The goal is to develop a short survey for use as a preliminary screen; patients with “red flags” would then be referred for additional assessment and support.

The P@HR CoP currently consists of 14 members from Malawi, South Africa, Swaziland, Uganda, and Zimbabwe, representing clinicians, Ministries of Health, people living with HIV, and civil society organizations. During monthly teleconferences, members of the group review evidence and existing resources, share experiences, and work to co-create a joint screening tool.

The group’s technical leads are Dr. Joanne Mantell (Columbia University, NY) and Dr. Herve Kambale (MoH/SNAP, Swaziland). The CoP will share the tool with the broader CQUIN network for feedback and inputs. Individual countries will be encouraged to pilot the tool.