The issue
Senegal plans a rapid scale up of HIV treatment for all people living with HIV (PLHIV), regardless of CD4 count or viral suppression. However, limited data exist on how to achieve sustained viral suppression among PLHIV in real world contexts where significant barriers to effective antiretroviral treatment (ART) delivery, uptake, and adherence persist.

Our approach
The purpose of this study is to develop and evaluate a universal coverage ART intervention among PLHIV who are not virally suppressed. Specifically, the study aims to: (1) determine the feasibility, fidelity, and cost-effectiveness of individual case management compared to standard of care in achieving sustained viral suppression; (2) assess the acceptability of HIV self-testing by people at high risk of HIV infection and whether the promotion of self-testing increases the number of newly diagnosed PLHIV in clinic setting; and (3) assess the acceptability of iris scanning as a strategy to enhance the measurement of follow-up and retention of PLHIV receiving ART. The study is an individual-level, randomized controlled trial that examines the impact of individual case management, compared to standard of care, on viral suppression among PLHIV over a 12-month period. A total of 596 clients recruited from two government HIV treatment facilities in Ziguinchor and two in Dakar are being enrolled in the study.

The impact
The results of this study will inform health care policy and practice in Senegal on the use of HIV self-testing approaches to increase the number of PLHIV diagnosed, case management interventions to improve care retention, and iris scanning to support measurement of retention in ART programs. Given Senegal’s leadership role across West and Central Africa, the results are likely to inform implementation of test and treat programs across this broad and diverse region.