ID: HR19-1338

Presenting author: Mohammad Shahidul Islam

Presenting author biography:

Dr. Mohammad Shahidul Islam is a public health professional working since 2002. Currently he is working with Save the Children as focal point for PWID and TCS intervention. After completion of medical graduation, he received Diploma in STI/AIDS. Dr. Islam has designed and implemented first ever ART program in Bangladesh.

Integration of antiretroviral therapy (ART) in drop in centers for people who inject drugs (PWID) increased ART enrollment and retention in HIV care: Bangladesh experiences

Mohammad Shahidul Islam, Lima Rahman

Background: Antiretroviral therapy maximally suppress HIV viral load and stop disease progression. It also prevents onward transmission of HIV and contributes in the control of epidemic. But these attainments are threatened in Bangladesh with high HIV prevalence (22% in 2016) among Dhaka PWID and also by very low level of ART enrollment (16%) and retention. To halt the epidemic through increase in case detection, ART enrollment and retention, Save the Children with the support of AIDS/STD Program has introduced peer led HTS and ART in selected areas of Dhaka.

Description of Intervention: As part of PWID epidemic response, peer based ART service delivery has been integrated in three selected PWID DICs of Dhaka in early 2017. To enhance enrollment in HIV care, annual HTS target was increased to 90%; peer led HTS started in the outreach; adopted ‘test and treat’ strategy for key populations; and ART DOTs for street based PWID was introduced through deployment of 'Case Workers' from the HIV positive PWID community. As a result, HIV case detection increased from 45 in 2015 to 222 in 2017 and thereafter ART enrollment has increased to 63% (374 against the cumulatively identified 589), which is five times higher than 2015 (17%). ART retention has also increased to 87% (324) from 40% in 2015.

Conclusions: Integration of peer based ART service delivery along with HTS strengthening in ongoing HIV prevention interventions has increased the horizon of essential services for PWID, ranging from awareness to ART and contributed in case detection, ART enrollment and retention.This and other forms of service integration at all level may represent a valuable intervention to end HIV epidemic.