| Strengths | Constraints |
---|---|---|
Availability | - Outreach peer educators in more than half of districts [D,R] | - Less than one-third of districts offering VCT/ART at district level in middle/low HIV burden provinces [D,R] |
- Two-thirds of districts offering VCT/ART at district level in high HIV burden provinces [D,R] | - Lack of physically accessible VCT/ART in remote areas in high/middle burden provinces [D,R] | |
Connectedness | Â | Â |
Hub & Heart | - Coordination mechanism between administrative detention centers and HIV outpatient clinics emerging [R] | - No coordination mechanism between districts with VCT/ART and those without [D,R] |
- HIV outpatient clinic ‘plus’ at district level expanded in high and middle burden provinces [D,R] | - Clinical services only in government funded HIV outpatient clinic at provincial level [D,R] | |
- No system to monitor expansion of outpatient clinic ‘plus’ [D,R] | ||
Chronological | - Chronic care based ART case management established for IDU and non-IDU [R] | - Limited capacity to address the needs of PLHIV on ART for many years [R] |
- Palliative care initiated integrated with cancer care [R] | - Pre-ART care under-developed [R] | |
- Linkage from VCT to pre-ART care under-developed [R] | ||
Horizontal | - HIV testing and counseling integrated into TB and antenatal care in donor funded districts with ART/VCT in high (and middle) burden provinces [D] | - Lack of linkage for HIV-TB and HIV-MCH in non-donor funded districts without VCT/ART in middle/low burden provinces [D] |
- Referral system between administrative detention centers and HIV outpatient clinics being developed [R] | - HIV service register not designed to facilitate TB/HIV and PMTCT [R] | |
Vertical | - Extensive mobilization of peer educators to facilitate MARPs to access VCT [D] | - Access to HIV testing and care and treatment in advanced stage of HIV infection [D,R] |
- Alternative approaches to reach hidden MARPs emerging [D] | - Health workers commonly providing verbal advice only to patients for referral across different levels of health facilities [R] | |
- CHBC models mobilizing a wide range of stakeholders [R] | - No system to monitor referral services [R] |