The Dominican Republic has come a long way in managing its HIV epidemic, reducing its incidence rate to 0.9 percent in 2017 after concerted effort from its government and international partners. However, with a treatment coverage rate of just 52% of estimated people living with HIV (PLWH), the nation is far from reaching the international goal of 90% of PLWH to be retained in treatment. Access – and adherence – to antiretroviral treatment (ART) is crucial to managing one’s HIV viral load, or the amount of the virus in one’s blood, as gaps in treatment can cause flare-ups of the virus and, if prolonged, lead to the development of AIDS.
Until July 2018, the Dominican Republic was one of the few nations globally which had not adopted the WHO-recommended “Treatment for All” strategy, which entails universal treatment coverage for all people living with HIV (PLWH), regardless of their viral status. Previously, the Dominican Republic legally guaranteed access to HIV care within their integrated service providers (SAIs), but set clinical restrictions for the initiation of treatment.
On July 27th, however, the Ministry of Public Health released the National Care Guidelines for HIV/AIDS, naming Treatment for All as its primary strategy for responding to the epidemic. The strategy is seen as key in reaching UNAIDS’s 90-90-90 goals: due to earlier initiation of treatment, Treatment for All can increase patient adherence to treatment regimens, a crucial factor for reaching viral suppression. Moreover, Treatment for All acts as a prevention mechanism to avert new HIV infections by increasing the number of PLWH with suppressed, or undetectable, viral loads, which renders the virus untransmittable. The strategy had been piloted in three regions of the country with support from PEPFAR, but will be expanded to the entire nation following the announcement of the new guidelines. This historic policy change comes after years of planning and support from international and NGO partners, of which the USAID’s Health Financing and Governance project (HFG) played an integral role.
The HFG project has been supporting this initiative since 2017 when it contributed to an impact modeling exercise that projected the costs and impact of implementing a Fast Track strategy, which includes Treatment for All, versus existing clinical prequisites for ART initiation. The project then led an evaluation of the 12 SAIs piloting the Treatment for All strategy, which included partner meetings, the development of a data collection tool, and site visits. Finally, HFG developed a scaled transition plan for the expansion of the strategy to the entire country by 2020. The 18-month transition plan outlines implementation procedures for the strategy across administrative, programmatic, operational and clinical dimensions; identifies potential risks and mitigation strategies; and establishes best practices for sustainability.
Treatment for All is expected to have a direct and positive impact in the fight to end the HIV and AIDS epidemic in the Dominican Republic. Based on projections developed by HFG, UNAIDS, UNICEF, and the Dominican Government, implementation of a Fast Track strategy can avert 8,366 more AIDS deaths and 7,900 more HIV infections over a 15 year period than the previous national strategic plan, which specifies clinical guidelines for initiating ART. Overall, the strategy including Treatment for All will reduce AIDS deaths by 57 percent and new HIV infections by 90 percent between 2015 and 2030. HFG is optimistic about the government’s decision to adopt Treatment for All and continue to work closely with the government of the Dominican Republic to improve the lives of all Dominicans living with HIV.