Small Investments With A Big Impact: Mobile ART for People Who Use Drugs in Sindh Province, Pakistan

This is part 2 of a blog series on innovation. In the first blog Nick Veldwijk, country manager Pakistan & Nepal at alliance partner Mainline explained the basics and the innovative work in Pakistan.

In this second episode Nick shares more details on the pilot from local partner Nai Zindagi*  in Pakistan on the mobile ARV unit.

April 2017. Friday night in Karachi, Sindh province, Pakistan. It’s 8pm. Karachi still bustles. Street vendors sell their wares, buses divert the crowd step by step and people are preparing for their evening prayer. Mohammad (39), recently diagnosed with HIV, is a husband and proud father of 2 sons. Also, he is an active drug user. To apply for his antiretroviral treatment (ART), he arrives at the ART centre in Karachi after a long trip. It is dark, and Mohammad finds out that the ART centre is closed. Exhausted and without money, Mohammad decided to find a calm, quiet spot on the streets of Pakistan.

Piloting an innovative mobile ARV roll-out

The example from Mohammad is reality in 2017. That time in Sindh province, only a couple of ART centres were available for registration. In order to overcome these issues for all their HIV+ clients, Nai Zindagi designed an innovative mobile ARV roll-out in collaboration with the Sindh local government. A trained medical practitioner provided ARVs in 5 districts, bi-weekly. Access to HIV treatment at the clients’ doorstep and initiation of Antiretrovirals (ARVs). Mohammad and many others had to travel long distances to special AIDS clinics in public sector hospitals. For every refill they had to come back. Imagine that you are an active drug user, HIV+, and had to cross dangerous district barriers with police checks, sometimes for more than 20 hours. With heavy cravings and some leftover drugs in your pocket…

April 2018. A small van is parked on the side of the road in a rural village in Sindh province. It’s Mohammad’s village. Mohammad enters and shows his prescription of ARV medication. The doctor hands over the ARVs and Mohammad continues with his duty of the day.

A small investment with a big impact

Thanks to the 6-months pilot a total number of 198 clients have received ARVs without any hassle. The number is increasing. Now, a total of 90,000 kilometers of clients travel distance is saved, i.e. approximately 2,500 hours of travel time. In monetary benefits, logistics cost with the social mobiliser, waiting time at the clinic and food would have cost approximately 15,000 euros in addition to the hassle of moving clients. An innovation that shows an increase in physical access to HIV treatment services in a cost-effective way, wasn’t kept unnoticed. In 2018, efficiency of the mobile ARV will be documented as part of a WHO evaluation —  small investments with a big impact.

Do you have an innovation to share?

Nick invites partners to share their innovations that act as catalyser to reach our end-goal: the end of the HIV/AIDS epidemic, as we believe that innovation can increase (efficient and effective) access and uptake of services, empower key populations to claim their rights, and reduce stigma and discrimination among service providers and health institutions. Do you have an innovation to share?

*Nai Zindagi is innovation partner with Mainline under the Bridging the Gaps programme supported by the Netherlands’ Ministry of Foreign Affairs. Furthermore, Nai Zindagi is principal recipient for the HIV, Malaria and TB programmes of the Global Fund in Pakistan.

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