Optimizing HIV Treatment in Mali

Related Global Health Areas
Lead Paragraph/Summary

Mali is progressing rapidly with the transition to optimized HIV antiretroviral (ARV) treatment and patient-focused delivery options at health facilities. To optimize HIV treatment, GHSC-PSM supports PEPFAR’s transition from legacy regimens to tenofovir/lamivudine/dolutegravir (TLD), the preferred first-line ARV for adults living with HIV.  

More Malians have access to lifesaving TLD than ever before, allowing people living with HIV to live long and healthy lives, contributing to PEPFAR’s goal of ending the HIV/AIDS pandemic as a public health threat by 2030.  

At the end of 2023, 98.36 percent of all people on ARV treatment in the Bamako, Sikasso, and Ségou regions of Mali had transitioned to TLD. USAID, through GHSC-PSM, has worked closely with the Ministry of Health's Sectoral unit for the fight against HIV, TB, and hepatitis (CSLS-TBH) to exceed initial targets from a starting point of just 7.3 percent in September 2019.   

How was this achieved?

Supportive supervision involves working with healthcare workers at clinics to optimize processes and update their knowledge and skills. It is a long-term, sustainable process whereby GHSC-PSM, the Ministry of Health, and healthcare workers collaborate to improve performance and improve health outcomes.  

Sixteen supervisors trained by GHSC-PSM have worked with more than 100 healthcare workers at 16 health facilities over the past three years, helping pharmacy, clinical, and laboratory staff to continuously evaluate and improve their work performance.

Supportive supervision sessions at HIV/AIDS care and treatment sites focused on the transition to TLD and improving treatment delivery.  

Patient-centric treatment delivery

Taking a patient-centric approach to treatment delivery provides numerous benefits to ARV clients and the health system.  

GHSC-PSM began supporting multi-month dispensing (MMD), providing a three-month (90-count bottles) supply of treatment per visit to the clinic. MMD of TLD is a high priority in the global fight against HIV. Reducing visits to health facilities saves patients time and money and gives clinicians more time with other patients in need.  

GHSC-PSM also offers alternative delivery options that take pressure off health facilities and brings HIV services closer to people's homes - decentralized drug distribution (DDD).  

In Mali, community-based distribution is an approach that involves the distribution of HIV drugs in convenient, accessible locations. In some cases, ARVs are distributed by psychosocial counselors working for NGOs and by community health workers and trained volunteers who take charge of distributing ARV directly in the communities where patients live. Drugs are issued to eligible clients in community centers, homes, or other designated local locations, which are more accessible to people and provide a more discreet means of receiving medication.

Together, MMD and DDD help minimize the burden on clients and the healthcare system. These strategies alleviate congestion in public facilities, enhance service accessibility, foster community involvement through the integration of community-based initiatives, diminish stigma, enhance treatment continuity, achieve HIV viral load suppression, and ultimately, enhance patient outcomes.