USAID Dumisha project supports two counties found in Western Kenya supporting two counties with a PLHIV on care and treatment of 59,162. The project had been facing interruption in treatment through lost to follow ups, defaulter, mortalities, and silent transfers. This was known to have associated with stigma, long distance to facilities which has led to client travelling long distances to seek services far away from their homes that is costly hence making clients miss their clinic appointments. Ahtiainen HK, Kallio MM, Airaksinen M, et al (2020); Costs of medication care were reduced in decentralized systems mainly in high-expense units. However, no evidence was shown that implementation of decentralized systems in small units would save costs.
The project identified 34 facilities that included 2 facilities per sub county. Sensitization of the staff was done through virtual meetings. This included impacting knowledge on how decentralized drug distribution points work for improvement of the quality of service. The criteria was to enroll clients who are classified as stable using the national guideline. Clients who are in community ART groups to remain in groups. the idea was to reduce the clients who yet to be enrolled in DSD as well as targeting to reduce the clients on fast track by advising them to be enrolled in decentralized drug distribution. Tools for data collection developed which included sections of documentation of key activities implemented.
This project was initiated on December 2021 with 119 clients enrolled in DDD, then progressed to 524 in January 2022, 683 in February 1060 in March and as end of April 2022, the project had enrolled 1173 clients. The methods being utilized include home delivery where drugs are ferried to clients’ homes and use of community chemists that are near the client’s location and can pick up their clients at their convenience.
Decentralized care to clients reduces burden to clients and improve clinic appointment which reduces the rate of interruption in treatment hence improving and sustaining quality of care.