BACKGROUND: Globally, prevention and treatment gaps for HIV/AIDS remain highest for key populations (KP). KPs are best served when KP-led organizations actively design their programs to address inequities. In January2020, Andhra Pradesh (AP) Government provided antiretroviral therapy (ART) services through a female sex workers (FSW) community-based organization (CBO) as a step towards community-led integrated programming and sustainability.
DESCRIPTION: We oriented the CBO staff on standard operating procedures on ART refill and routine monitoring of People Living with HIV (PLHIV); tracking and tracing; decentralized specimen collection for viral load (VL) test; and recording and reporting into national information management system. With an overall aim of ensuring treatment continuity and durable VL suppression, we focused on publicizing U=U (undetectable equals untransmittable) messaging to garner the power of treatment adherence, reduce stigma, and create an enabling environment.
LESSONS LEARNED: During January2020 to November2022, CBO provided care to 405 FSW PLHIV, including 21 lost-to-follow-up who opted to re-engage in care due to community-led-services. Two-year retention of PLHIV linked to CBO was 98% (397/405). VL coverage increased from 21% to 92% and suppression from 77% to 94%? (p<0.05) respectively.
During COVID pandemic surge (March-June 2021), CBO could extend its scope and additionally enrolled non-KP PLHIV (576) for ART refills who still continue to avail ART services without any hesitancy, with 95% retention and 93% VL suppression.
Of the total 981 KP and non-KP PLHIV enrolled, CBO facilitated social entitlements for 412 and nutrition/ration support for 25 PLHIV by leveraging district administration.
Based on the results, this intervention has been adopted as national policy for amplification and currently is being scaled up to other 29 NGOs/CBOs in AP.
CONCLUSIONS: Community-led service delivery, including U=U messaging and social security improves ART continuity and VL suppression, by addressing key barriers related to equity, stigma and discrimination. This model facilitated normalization of perceived barriers and stigma as reflected by continued access of services by non-KP from the CBO for ART as well as overall health and social needs. Therefore, such models have potential to transform and mainstream KP community-led programming through key population leadership for an inclusive service delivery, to close the equity gaps.

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