An Integrated Approach to ARV Delivery: IPPF's experience in the Dominican Republic

Background: PROFAMILIA, IPPF's Member Association in the Dominican Republic, piloted a one-year project to introduce comprehensive HIV/AIDS treatment and care into two of its sexual/reproductive health (SRH) clinics. At the time, most Dominicans in need of antiretroviral (ARV) treatment had no access.

Design/Methods: The treatment approach rested on seven key elements: staff training, a multi-disciplinary team approach, pre- and post-test counseling, laboratory tests, support groups, and monitoring treatment adherence. IPPF conducted evaluation via case studies and focus groups, review of service statistics, and implementation of pre- and post- knowledge, attitude, and practice (KAP) surveys.

Results: After one year, PROFAMILIA was providing services to more than 165 HIV-positive clients, with 67 receiving ARV treatment and an adherence rate of 95%. KAP analysis indicated improvements in staff knowledge and attitudes. Focus groups identified numerous health and psychosocial benefits to providing HIV treatment and care in an integrated clinical setting.

Conclusion: Multi-sectoral partnerships, one-on-one staff training and supervision, multidisciplinary team approach, and empowering clients through self-run support groups all proved to be critical elements of this model. Programmatic challenges included long-term sustainability concerns, including staff time, funding, and continuous access to ARVs. Both clinics are now in the Dominican National AIDS Care Network, and the government will also replicate PROFAMILIA's model of care.