Kinshasa is working with community-based organizations to improve and increase uptake of HIV services, including for paediatric and maternal care and treatment adherence. Over a fifth (22%) of the Democratic Republic of the Congo’s people living with HIV reside in Kinshasa, where resources are often limited and a number of services are difficult to access. Working with communities can improve the efficiency and effectiveness of resources, and ensure that services are both accurately targeted and appropriate.
Landela: Using technology to improve paediatric care
Paediatric treatment has improved in Kinshasa with the involvement of the local NGO “La Main sur le Coeur” (“Hand on heart”), a women-led organization established to ensure care for children orphaned and otherwise affected by HIV. With support from the city and UN agencies, La Main sur le Coeur developed the Landela digital platform to improve HIV services for women and children. The tool was then rolled out in hospitals, including maternity hospitals. The platform uses a unique identifier with fingerprint and QR code to reduce double counting of women and children living with HIV and improve patient follow-up. Landela is accessible in two versions, a web platform and a mobile application.
The Landela platform enables the digitalization of patient files and helps health care staff to monitor and manage stocks of antiretroviral medicines; access to HIV services; adherence to treatment; and medical prescriptions. The project also supports 12 peer educators who provide community-based support for adolescents living with HIV, including for adherence.
Landela was launched in the Kalembelembe paediatric hospital (the largest in Kinshasa), and has significantly improved service quality and delivery and retention in care among pregnant women and children living with HIV. Both treatment coverage and adherence to treatment have increased. As a result of this success, Landela has now been rolled out in four additional maternity wards and two additional hospitals (including Camp Lufiungala Police Hospital,) as well as in four other cities (Goma, Kisangani, Lubumbashi, and Mbuji-mayi). Since the start of the project, 70 health care providers and peer educators in all of these locations have been trained in the use of the Landela mobile application, and 107 women, young people and peer educators have learned about the prevention of mother-to-child transmission of HIV.
Community ART distribution
The Réseau National d’Organisations à Assises Communautaire (RNOAC) is a national non-governmental organization that provides treatment and psychosocial support for people living with HIV, and combats HIV-related stigma and discrimination. In collaboration with the city, RNOAC runs community ART distribution points (PODI) to help increase ART adherence. Clients collect ART refills from the PODI – staffed by expert peer volunteers – every three months. They are screened for weight and basic symptoms, and referred if they are unwell. They can also access group adherence support. Every year they must attend a health facility for laboratory tests as well as clinical monitoring and assessment by a nurse and/or doctor, who will also renew their ART prescription. In 2020, eight of the city’s 448 ART sites were PODI, serving 19,148 patients, of whom 211 were new clients.[1]
During the COVID-19 pandemic, the PODI have been even more vital to ensuring uninterrupted access to treatment for people living with HIV. Training has been carried out for 10 health care providers and 20 community-based peer experts to improve the care provided to patients. Other COVID-19-related interventions include the reactivation of a toll-free number for networks of people living with HIV to ensure continuity of HIV services. The service provided alerts in case of ARV stock-outs and issues in accessing services (including those related to stigma and discrimination), and shared information on COVID-19.
Kinshasa is the epicentre of the country’s COVID-19 pandemic, with over 59% of all confirmed cases in October 2021. From the start of the pandemic, HIV stakeholders have worked with others in Kinshasa and at the national level to advocate with the Global Fund for access to emergency funds to ensure continued care for people living with HIV. As a result of this advocacy, Kinshasa and the country more widely have benefited from US$ 32,702,672 in 2020 and US$ 19,246,197 in 2021 to mitigate the impacts of COVID-19 on HIV, TB and malaria programming. The National AIDS Control Programme (PNLS) and the National Multisectoral Programme for the Fight against AIDS (PNMLS) worked with networks of people living with HIV (UCOP+ and Femmes Plus), and with the support of UNAIDS, WHO and PEPFAR, to ensure the best use of these funds.
[1] Programme National Multisectoriel de lutte contre le Sida, Secrétariat Exécutif Provincial de Kinshasa. Rapport annuel de la riposte au VIH/SIDA: Exercice 2020. 2021.
