Instances of conflict or natural disasters frequently result in the destruction of health and community structures, other services, and infrastructure, making it challenging to provide HIV services to internally displaced people and those affected by humanitarian crises (19). Our encounter was as described. However, we won't achieve zero new HIV infections, zero discrimination, and zero AIDS-related deaths unless HIV is addressed when assisting those affected by humanitarian situations (19). Different DSD models are being applied to broaden ARV access in challenging areas (7). These include, but are not limited to, community ART groups, mobile clinics, patient-led community ART distribution sites, and home-based ART dispensation (20–23).
Despite being reportedly expensive and logistically challenging, community-based models in the form of mobile clinics have been used successfully in conflict-affected settings to provide primary healthcare (25) and HIV services in remote, hard-to-reach settings (24, 26), including the Cameroonian setting (17). A competent workforce was used in our facility-led community-based approach (FLCBA) paradigm of care for DSD (Table 2). This model has been demonstrated to be an efficient way to reduce program retention hurdles and produce good rates of virologic suppression; as a result, it suitable for DSD HIV services and treatment which is brought closer to communities on a regular basis (27).
The teams used FLCBA to test positive, a total of 5.5% of people in the district's 11 targeted health areas. This number is higher than the national prevalence (2.7%) and regional prevalence (3.2% SW), albeit the South-West prevalence primarily accounts for the situation in urban areas. This demonstrates how crucial it is to have evidence-based DSD for HIV particular to these insecure, isolated environments. All clients who received a new diagnosis were connected to care and therapy.
The high levels of insecurity in these places, the distance that PLHIV must go to receive ARV, and the cost of transportation have all been proven to contribute to gaps in retention to care and unsuccessful links to care (17). To circumvent this obstacle, our teams made community-bound trips and successfully located 61% of missing clients using FLCBA. Though due to exceptional unsafe circumstances, some journeys had to be cancelled. Our strategy had a flaw in that we couldn't properly trace every defaulter and LTFU back to ARV therapy. Due to a variety of factors, including inaccessible phone contacts throughout their tracking, our teams were unable to fill in these gaps. Poor network deep in the rural communities, a lack of electricity to power phones, or a lack of phones were some of the other related causes. Additionally, they found that PLWHA frequently unexpectedly migrated from their former residence in response to unpredictable insecure incidents or in pursuit of a better way of life, despite the lack of a precise quote on the next location. To overcome the issue of distance to care, partnerships with satellite health clinics in rural areas through the provision of ARVs acted as hubs to serve some clients in the extremely remote settlements in the bushes.
Between clinical sites (urban, peri-urban, and rural) and centralized laboratories, viral load monitoring calls for coordinated transportation of specimens and results (29–31). With the help of our facility-led community-based strategy, we successfully identified and collected viral load samples for 72% of the targeted eligible clients in order to facilitate the current constraints. Reasons for the gaps mirrored those of linkage. However, in carrying this out, we ran into a number of obstacles: clients missed community appointments since some prioritized farming schedule. Additionally, it could take longer to return samples to the facility for preparation and storage before transportation to the central laboratory, making cold chain handling of samples in transit troublesome. Also, blood samples were drawn in below-average quantity. Plans for the transportation of samples for analysis have been thwarted by lockdowns. Additionally, the destruction of the medical institution resulted in the loss of samples and significant difficulties with sample processing and storage.
Using the words of the UNHCR High Commissioner, he declared that "Programs aiming to reduce the stigma and discrimination faced by refugees, IDPs, and migrants need to be implemented at all levels, at the national level, they need to be included in HIV/AIDS National Strategic Plans, policies, and funding proposals." The results thus far are depressing, he said. Since 2006, fewer refugees have been included in HIV National Strategic Plans. In 2008, only 32 of the 46 nations hosting more than 5,000 refugees had National Strategic Plans that could be examined. 14 of them, or roughly 44%, made no mention of refugees (32). Our country health systems will gain immensely from unique national HIV policies and strategies geared to humanitarian circumstances.
In this paper, we attempted to capture the experiences, results and challenges with implementing facility-led community-based approach as a model of differentiated service delivery for PLWHA in humanitarian settings. The targets with respect to various aspects of the HIV cascades are specific to the FLCB approach and so do not reflect the global figure. A more comprehensive evaluation may be required to assess with completeness, the potentials of all approaches employed to provide patient-centered care to this underserved population.