In the Dominican Republic, adapting critical HIV services for vulnerable families amid Covid-19

In March 2020, the first case of coronavirus was detected in the Dominican Republic (DR). From the onset of the pandemic, the Dominican government has followed World Health Organization guidelines, taking national measures to reduce deaths and the spread of the disease. In July 2021 alone, more than 340,000 cases were reported, and the country remains under a declared state of emergency.

But Covid-19 is far from the only health challenge in the country. The Dominican Republic grapples with a concentrated HIV epidemic, with a significantly higher prevalence among certain vulnerable populations. ACHIEVE, a five-year, USAID-funded global health project, is working to stop HIV. Led by Pact, ACHIEVE’s goal is to reach and sustain HIV epidemic control among pregnant and breastfeeding women, adolescents, infants, and children in countries across the world.

In five provinces in the Dominican Republic, the project uses a comprehensive case management approach to improve the health and well-being of highly vulnerable HIV-positive people and their families.

"ACHIEVE serves as a bridge between families and health and socioeconomic support services,” says Pact’s Desirée Luis, ACHIEVE’s Project Director in the Dominican Republic. “We connect families with providers who contribute to their well-being and their path to resilience."

The Covid-19 pandemic deepened existing inequalities in the Dominican Republic, including within ACHIEVE’s priority population, whose livelihoods often depend on informal work. Their sources of income have been limited because of Covid-19 restrictions, including the national curfew. These new financial strains have posed a significant challenge to the families that ACHIEVE serves, making the project’s economic interventions even more important.

ACHIEVE provides vocational training and start-up materials to families to help them start small businesses.  Families also receive food support, as people living with HIV have specific nutritional needs that must be met for them to be able to successfully remain in treatment.

Travel restrictions and fear of Covid-19 have led to hesitancy about leaving the house to obtain critical HIV services and ACHIEVE responds with house visits. Household by household, ACHIEVE works to ensure that the families it serves continue to get the care they need. During the visits, project staff and volunteers take precautionary measures to limit Covid-19 exposure for themselves and the families they work with while evaluating the family’s needs and providing access to relevant services. They carry emergency responder badges so that they can conduct visits even during curfews, and they maximize phone-based case management when needed. ACHIEVE has trained community members and volunteers on Covid-19 prevention and response and has distributed thousands of informational brochures in Creole, along with personal hygiene materials and personal protective equipment. After the earthquake occurred in Haiti on August 14, 2021, the same strategy that we used during the beginning of the pandemic is being implemented.

In coordination with clinical partners, the project offers HIV testing at community sites and homes and delivers life-saving antiretroviral drugs to those that need them. ACHIEVE provides safe transportation to clinics for individuals and families requiring medical attention and actively facilitates Covid-19 vaccination for its staff and beneficiaries. In coordination with donor institutions, the private sector, and the Dominican government, ACHIEVE has helped oversee donations of food, hygiene materials and school supplies, and has facilitated access to social protection programs for those that need them most. 

As families impacted by HIV grapple with the medical and economic hardship created by Covid-19, a separate but related crisis has unfolded around the world: a significant rise in gender-based violence and violence against children. ACHIEVE has responded in the Dominican Republic by strengthening its staff’s ability to detect cases of violence and coordinate with relevant authorities to respond. The project, alongside the Attorney General’s Office, delivered a webinar on comprehensive care for victims of abuse, as well as a webinar for community personnel on identifying and handling abuse cases.

Despite the many challenges presented by Covid-19, the ACHIEVE team in the Dominican Republic has helped families to be resilient. “I have become more motivated,” says Marleny, an ACHIEVE beneficiary who is living with HIV. “I am taking my medications correctly, and I go to my appointments in a timely manner. I’ve gained knowledge to help other HIV patients.”

Samantha, a mother whose family works with ACHIEVE, says her son is thriving thanks to the project’s support. "I never thought my son could have HIV, much less that he could be saved,” she says. “But he is already in very good health.”