Liberia's successful expansion of antiretroviral therapy refills through community pharmacies and community-based organizations

BACKGROUND: Provision of client-centered differentiated service delivery (DSD) for antiretroviral therapy (ART) is recommended by the World Health Organization (WHO).Liberia has about 19,000 people living with HIV (PLHIV) on ART. Treatment interruption, due to stigma and long travel distances to treatment sites, is an enduring concern. The USAID and PEPFAR-funded Meeting Targets and Maintaining Epidemic Control (EpiC)project piloted decentralized drug distribution (DDD) through private pharmacies (PPs) and one community-based organization (CBO) in Monrovia, Liberia, to address these issues.
DESCRIPTION: DDD was piloted in Monrovia beginning in April 2021 in one health facility, and from September 2021 in two health facilities, through a collaborative partnership with the National AIDS Control Program (NACP), Liberia Pharmacy Board, health facility management teams, and the Liberia Network of People Living with HIV (LibNeP+). Health facility and PP providers were trained on DDD. A memorandum of understanding was established between the three collaborating health facilities, PPs, and the NACP. Clients established on treatment were offered the model and selected one ART pick-up location from 26 PPs and one CBO (a LibNeP+ office) for their next ART refill. The LibNeP+ office was added as an option in October.
LESSONS LEARNED: Between April and November 2021,1,314 clients established on treatment were offered enrollment in DDD. One Hundred and twenty-four (9.4%) clients accepted and were enrolled from three high-volume health facilities. Ninety clients (77 [85.5%] female; 13 [14.4%] male) chose PPs, and 34 clients (16 [47.1%] female and 18 [52.9%] male) chose the CBO as their preferred pick-up location. Despite the high interest in DDD expressed by PLHIV at the health facility (52% of 58 clients established on treatment who were surveyed at baseline), the initial enrollment was slower than anticipated. Client concerns expressed during health talks included fear of confidentiality breach and losing contact with their clinicians.
CONCLUSIONS: DDD is feasible in Liberia. However, expanded pick-up points and targeted counseling to address client fears regarding confidentiality are necessary to sustain the program in Liberia. More work is needed to understand sex-related differences in model choice.

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