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Less frequent clinic visits for HIV care: fine tuning needed
Keith Alcorn, 2017-07-24 17:00:00

Shifts to less frequent clinic visits and medication pick-ups to free up healthcare resources and make life easier for people living with HIV are being implemented successfully in some African countries, but still need fine tuning, several studies presented on Monday at the 9th International AIDS Society Conference on HIV Science (IAS 2017) show.

The studies looked at the practice of multi-month prescribing, by which clinics provide several months of antiretroviral drugs at one time to people living with HIV in their care, in order to reduce the need for monthly clinic visits to pick up refills of medication. Frequent clinic visits can be difficult to manage, especially if the clinic is a long way from home, transport is unaffordable or working hours prevent attendance at the clinic.

Less frequent clinic visits have been associated with better retention in HIV care in a large study in Zambia, and in other southern African countries, and also have the potential to reduce clinic congestion and increase the number of people who can be started on antiretroviral therapy (ART) as countries move to 'Test and Treat' guidelines recommending treatment for all people living with HIV.

The practice of multi-month prescribing is central to the concept of differentiated care, through which people with less complex medical needs can receive more care in the community in order to free up medical resources for people who are sicker, those starting treatment and those with viral rebound.

Multi-month prescribing will not be suitable for everyone. In Malawi, for example, multi-month prescribing is offered to adults who have been on ART for at least six months, who have a viral load below 1000 copies/ml and good adherence. People with opportunistic infections or tuberculosis are required to attend the clinic more frequently. These criteria are designed to ensure that people with more complex clinical needs, and those who have recently started treatment, are not lost to follow-up.