Care and Treatment for Sustained Support
The Care and Treatment for Sustained Support (CaTSS) Project (2016–2019) was implemented by MSH in close partnership with the Government of Nigeria and local partners. Funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID), the project advanced Nigeria’s efforts to achieve HIV epidemic control and reach the ambitious 95-95-95 goals: 95% of people living with HIV are diagnosed; 95% of those diagnosed HIV positive are started on antiretroviral therapy (ART); and 95% of people currently on ART are virally suppressed. The project brought about significant improvements in case finding and treatment outcomes for HIV and AIDS and TB across five states in North West Nigeria: Niger, Kwara, Kebbi, Sokoto, and Zamfara.
To support self-reliance and sustainability, CaTSS implemented a peer mentorship program that transferred critical HIV patient and program management skills to frontline health workers and state ministries of health. This initiative enhanced the capacity of state governments to plan, manage, and lead HIV and AIDS and TB programs at the state and local government levels while strengthening the capacity of health care facilities to provide sustainable, integrated, quality HIV and AIDS and TB services.
CaTSS successfully managed the introduction of new policies such as Test and Start and new programmatic requirements such as high-frequency data reporting. The CaTSS-supported deployment and use of the electronic medical record system in all project-supported facilities significantly improved the project’s ability to respond to the demand for frequent data reporting, ensure patient-centered quality of care, and adaptively manage the program. This positioned health care facilities to improve testing efficiencies, linkage, and retention, as well as viral suppression among patients.
- Tested more than one million people for HIV and supported nearly 35,000 people to adhere to lifesaving ART.
- Increased the percentage of new HIV-positive individuals linked to HIV treatment from less than 65% to more than 95%, achieving a 98% linkage rate by the end of 2019.
- Significantly improved the coverage of viral load testing and viral suppression rates in project-supported facilities and states. By the end of the project, 94% of patients on ART had their viral load tested and 85% of those had an undetectable viral load, making them much less likely to transmit the virus to their partners or children.
- Scaled up index case testing, a high-yield HIV testing intervention, to reach sexual partners and biological children of newly diagnosed people who may not know their HIV status. In 2019, 93% of newly identified positive clients at project-supported facilities were offered index case testing, 19% of whom tested positive for HIV compared with 4% in 2018. This trend was maintained into 2020 and saw the offer rate increase to 96% and the case identification rate to 22%.
- Employed a patient-centered approach, trained case managers to provide and maintain high-quality care for a fixed pool of clients, improved the client facility visit experience, increased the number of appointments attended, increased viral load testing uptake, and improved adherence to treatment.
- Worked with facility staff to scale up the transition to the WHO-recommended first-line antiretroviral (ARV) regimen known as TLD, placing more than 83% of its overall client load on TLD by December 2019.
- Conducted supportive supervisory, mentoring, and coaching visits to health facilities in the five project states to improve the delivery of equitable and client-centered prevention of mother-to-child transmission services to HIV-positive pregnant or breastfeeding women and their infants. Over the life of the project, 415,624 pregnant women who attended antenatal care in supported health facilities were provided with HIV testing services and learned their HIV status the same day. Of the newly identified HIV-positive pregnant women, 97.3% were started on ART to prevent mother-to-child transmission.
- Rapidly scaled up the implementation of the OpenMRS electronic medical record system in 107 health facilities. Through CaTSS support, the five project-supported states now have patient data and can capture progress toward the 95-95-95 goals.