Dr Nyla Lyons, a Public Health Specialist at the Medical Research Foundation of Trinidad and Tobago

What do you want people to know about DSD in Trinidad and Tobago?    

The Medical Research Foundation (MRF) is a non-governmental organization and the largest HIV/STI service provider in Trinidad and Tobago. With support from the government, the MRF began implementing differentiated service delivery (DSD) in 2017. DSD has improved the efficiency and resilience of our health system and accelerated us towards meeting the UNAIDS 90-90-90 targets, with access to treatment expanding to 73% of all people living with HIV at the end of 2018.

Improving the quality of HIV care through DSD continues to be a priority. Community- and peer-led interventions, telehealth services and decentralized ART delivery have been critical for ensuring access to treatment during the COVID-19 pandemic.

DSD models in Trinidad and Tobago serve as best-practice examples for other developing countries, both within the Caribbean and internationally.

You presented a late-breaker poster at AIDS 2020: Virtual. Can you tell us a bit about the impact of the COVID-19 pandemic on HIV services where you work?

Beginning in March 2020, our government implemented measures to avert community spread of COVID-19, which included restricting public gatherings and shutting down non-essential services. As a result, there was a reduction in the number of clients adhering to their scheduled ART appointments, as well as reduction in demand for clinical services, including testing and counselling for HIV and other STIs, viral load testing, testing for non-communicable diseases, and clinical follow up and management of unstable clients (clients with viral loads >1,000 copies).

In response, the MRF expanded implementation of DSD, including community ART pick up and delivery services facilitated by “patient peers” and supporting telehealth services. [Read the AIDS 2020: Virtual late breaker here.]

The role of “patient peers” in your setting has been strengthened in response to COVID-19-related service delivery challenges. Can you tell us a little more about how these peers support DSD in Trinidad and Tobago?

Through community networks of people living with HIV, “patient peers” play an integral role in scaling up DSD in Trinidad and Tobago. These peers serve as a conduit to HIV services and work in collaboration with the clinicians at the MRF, assisting in linking newly diagnosed clients to treatment, monitoring and re-engaging clients in care, facilitating the delivery of medication and providing psychosocial support to clients affected by COVID-19. “Patient peers” also use social media to keep clients and communities informed and serve as a medium to connect patients to essential services during the stay-at-home period.

What changes have you made to your DSD programme because of COVID-19 that you think will persist and improve care even when the pandemic is over?

The COVID-19 pandemic will continue to have an impact on the way HIV services are delivered. It is critical that we continue efforts to decentralize ART and scale up community ART delivery models, expand telehealth services and further integrate “patient peer” services to meet the needs of vulnerable populations. The MRF will also continue to use data to monitor and evaluate the implementation and outcomes of DSD programmes with a view to scaling programmes with the greatest impact.

What data do you hope to submit to AIDS 2022?

For AIDS 2022, we hope to present retention and viral suppression data on the effectiveness of our expanded DSD interventions. Having evaluated the impact of our DSD programmes in this way, we also hope to present results of cohort studies, comparing our services with other countries in the region and further afield.