As drugs, funding, and ethics align for universal treatment of HIV-infected persons worldwide, demand for service threatens to exceed existing healthcare infrastructure. Developing countries need novel methods to diagnose HIV-infected people, recruit them into care, and achieve long-lasting viral suppression.Methods:
The University of Maryland Community HIV Epidemic Control (CHEC) model is an innovative community-based approach to the HIV care continuum. A community health worker, equipped with a tablet linked to the national electronic health record, offers HIV testing and health messaging to all members of the community. Persons testing HIV+ are referred to a healthcare facility and followed up to ensure they are in care and receiving treatment; any HIV-exposed infants are followed through the testing cascade. CHEC currently provides Option B+ to pregnant women, community ART based on national guidelines, and community ART with a Test and Start approach.Results:
To date CHEC has been implemented in over 100 sites in Zambia, with more than 400 CHWs trained and deployed. In the first year of CHEC deployment, HIV testing rose from 21,051 to 71,289 clients (339% increase), of whom 20,623 (29%) were tested in the community. Major PMTCT indicators, such as ANC testing, HIV+ pregnant women on ART, and HIV-exposed infant testing, all increased 3- to 5-fold. Initial cost analysis shows that after initial startup, one CHW can follow 500 clients for $4-5 per client per year.Conclusions:
The CHEC model represents a novel and cost-efficient community-based approach to achieving the UNAIDS 90-90-90 goals of epidemic control and offers a durable solution to healthcare system strengthening in sub-Saharan Africa.