Addressing barriers to HIV care during the pandemic in the DR

In the Dominican Republic, SHOPS Plus facilitates collaboration between NGO providers of HIV services and the government of the Dominican Republic to enroll people living with HIV (PLHIV) in Seguro Nacional de Salud (SENASA), the national health insurance program. Once PLHIV enroll in SENASA, the insurance company will reimburse contracted NGO providers for their HIV care services, addressing potential financial barriers that PLHIV face in accessing care and providing NGOs with a sustainable domestic revenue source.

Attendees at SHOPS Plus training
In February, SHOPS Plus trained health promoters on enrolling people living with HIV in the national health insurance scheme. (Photo: Erika Suero, February 2020)

Historically, SHOPS Plus has worked with NGO providers to enroll PLHIV during their monthly visits to pick up antiretroviral medicines. However, with the onset of the COVID-19 pandemic, social distancing requirements led these providers to adopt new service delivery models that limit their direct interactions with clients. While this curbs the spread of the virus, it also reduces the number of times health care facilities have contact with PLHIV—and thus the number of opportunities they have to enroll them in SENASA. As people with pre-existing conditions, such as HIV, are especially vulnerable during the pandemic, enrollment is more critical now than ever.

SHOPS Plus has supported the adoption of new protocols to increase enrollment while mitigating the potential impact of the pandemic. As health facilities now dispense several months of antiretroviral therapy at once to reduce unnecessary client visits, SHOPS Plus is working with the National Health Service and NGOs to provide health promoters with the guidance needed to facilitate enrollment in patients’ homes. Mina Halpern, the executive director at one such NGO, Clinica de Familia, explained, “Our health promoters have continued to provide support to our most vulnerable clients, delivering their medications directly to their homes.” During these home visits, health promoters have PLHIV complete an enrollment application and collect the documentation necessary to submit their applications to SENASA.

In addition, SHOPS Plus has continued to advocate for the prioritization of PLHIV in enrollment. The Dominican government has a limited number of slots for individuals to enroll in SENASA each year. SHOPS Plus is working with SENASA to give PLHIV priority status, meaning that they would have a higher likelihood of successfully enrolling in a given calendar year. Without access to enrollment, PLHIV—and the NGOs that serve them—would have to continue relying on international donor support.

By rapidly implementing new strategies and continuing crucial advocacy work, SHOPS Plus is supporting the Dominican government to ensure that PLHIV can receive the HIV services they need during the pandemic and beyond.

Learn more about our work in HIV.


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Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.

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