Utilizing hub riders for effective linkage and enrolment of clients into HIV care at lower level healthcare facilities

UNAIDS recently published an ambitious plan—90-90-90—to end the HIV epidemic. It aims, that by 2020, 90% of people living with HIV will know their status, 90% of them will receive sustained antiretroviral (ARV) therapy, and that all people receiving ARVs have a viral suppression of 90%. Although many strategies are needed to control the HIV epidemic, one thing is certain: it will be impossible to end the epidemic without bringing HIV treatment to all who need it.
To ensure that all HIV patients (newly identified and old patients) are on lifelong treatment, USAID’s Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) project has started to utilize the enormous resources provided to supported hospitals for effective linkage and enrolment into HIV care. At Hoima Regional Referral Hospital (RRH), the project also supports the laboratory hub sample transportation network. Lab samples at mapped lower level healthcare facilities are collected by a hub rider using a motorcycle, brought to the RRH laboratory for analysis, and returned to those different facilities to aid diagnosis. Additionally, hub riders take the names of all HIV-positive clients who opted for care away from the hospital and were referred to the different healthcare facilities. Therefore, the teams at the lower-level facilities can verify their enrolment and/or prepare to receive the clients when they arrive—ensuring that they will be receiving the necessary care.
As part of the process to strengthen health systems at Hoima RRH, USAID/SUSTAIN provided a job aide as well as oriented and coached healthcare workers on how hub riders can be utilized to ensure successful linkage and enrolment of clients who opt for HIV care away from the hospital. Charged with the role of ensuring patient tracking for treatment, Fred Kusaasira, the Community Linkages Coordinator for Hoima Hospital, has expressed how the initiative has assisted the hospital to successfully link and enroll clients and contributed towards quality data.
Fred Kusaasira, the Community Linkages Coordinator, hands enrolment forms to a hub rider before he sets out to lower level healthcare facilities. 

“The HIV counseling and testing (HTC) teams spread all over the hospital units share with me daily enrolment referral forms bearing names and other patient details of all clients referred to the different healthcare facilities for enrolment into HIV care. I then arrange those forms according to the hub rider’s destinations that day. As he delivers and collects lab samples at those different lower level healthcare facilities, he also delivers the enrolment referral forms to the different HIV units for the healthcare provider to verify enrolment of the client, and/or prepare to receive them. He brings back to the hospital a copy of the enrolment form completed by the health worker from the receiving facility. The hospital then updates the HTC register to show that clients are successfully linked and enrolled outside of the hospital.”

Between October and December 2015, the initiative successfully linked and ensured effective enrolment of 30 out of 48 clients who opted to receive HIV care elsewhere. Clients who do not arrive at the HIV care facilities where they opted to enroll are followed up through telephone calls for continuous in-depth counseling to help them start on treatment.
According to Mr. Kusaasira, there is so much satisfaction in providing a complete service to a client, “Ensuring every identified HIV-positive client is successfully enrolled into care is a first step towards saving life and, ending the HIV epidemic. Moreover, this initiative has assisted us in receiving quality data in addition to building working relationships with lower level healthcare workers, systems we need to effectively manage HIV in Uganda.”
Mr. Kusaasira explains how the hub riders have been utilized for successful linkage of clients to lower level facilities
Written by Bernadeta M. Nagita,  Executive and Communications Officer, USAID/SUSTAIN Project