How Dutch funding proves to have a multiplier effect in Pakistan’s HIV programming.

Nai Zindagi, Mainline’s partner in Pakistan, has developed a facility where people who use drugs are initiated on antiretroviral treatment (ART). This pilot was funded under the Bridging the Gaps programme since 2014. As per 1 January 2016, this ART Adherence Unit (AAU) is included in the Global Fund country programme which has doubled the capacity of the unit. For Nai Zindagi this is yet another recognition of their intelligent strategy to integrate innovative pilots in larger programmes.

HIV epidemic driven by drug use

In Pakistan nearly forty percent of people who inject drugs (PWID) are living with HIV. Needle exchange programmes are recognized as harm reduction interventions to prevent HIV among street based PWID/ However, opiate substitution therapy (OST) has not yet been approved in spite of on-going advocacy at scale.

Comprehensive services

The Global Fund supports comprehensive HIV prevention and harm reduction services to street based PWID, families and intimate partners in 28 districts of Pakistan. The services are based on continuum of prevention and care models including HIV testing and counselling (HTC), mobile CD4 diagnostics, access to ART, care and support. Antiretrovirals are provided through public sector facilities.

Nai Zindagi’s AAU

Between 2011 and 2013, only 28 PWID living with HIV were accessing antiretrovirals. Between 2014-2015 this number rose to 1,269. Approximately 80% of them were admitted through Nai Zindagi’s AAU. The AAU, particularly in the absence of OST, is the only option available in Pakistan that focuses on ensuring adherence to ARVs for PWID. Thanks to the AAU, a large number of PWID could be registered and receive ARVs from public sector facilities.

Detox

Detoxification is part of the AAU¹s residential treatment preparedness. In general Medical professionals at the ART centres are reluctant to give ARVs to active drug users. However, after two years 62% of the clients have relapsed into drug use, while 68% are still adhering to their HIV treatment. These results prove that people who use drugs can very well be adherent to ART.

Doubling the capacity of services

Key stakeholders including the Global Fund, National and Provincial AIDS control Programmes, UNAIDS, UNODC, WHO and Association of People living with HIV/AIDS have been closely engaged in the development and roll out of the AAU services. Lessons learned have been well documented to improve quality of services at the AAU. As a result the Global Fund has agreed to financially sustain the AAU at double the capacity (100 in residence to 200 hundred in residence) from January 2016.
For street based persons using drugs, living in poverty and affected by HIV & AIDS, the AAU is currently the only link for ART adherence in the absence of OST. The creative programming of Nai Zindagi in an environment that is still very hostile towards drug users, has proven successful. Bridging the Gaps congratulates Nai Zindagi with this great accomplishment.

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