Background: In West and Central Africa, 48% of people living with HIV (PLHIV) are aware of their status, 40% are accessing antiretroviral therapy (ART), and 29% are virally suppressed. Progress is stymied by drug stock-outs, weak health systems, human rights barriers, and low quality of care. In February 2017, the International Treatment Preparedness Coalition (ITPC) established the Regional Community Treatment Observatory in West Africa (RCTO-WA) to increase accountability for the 90-90-90 targets.
Methods: ITPC trained and supported national networks of PLHIV to collect and analyze facility-level data along the HIV treatment cascade from 103 health centers in 11 West African countries. From July 2017-June 2018, the RCTO-WA conducted 538 health center visits, 279 key informant interviews, and 110 focus group discussions. In this paper, we share the first year of RCTO-WA community monitoring findings, analyzed using the ''Five As'' framework?availability, accessibility, acceptability, affordability and appropriateness.
Results: Availability: ART stock-outs were recorded during 23.4% of health facility visits (95% confidence interval [CI] 19.8%-27.0%), lasting an average of 40.5 days (95% CI 34.2-46.7). Stock-outs were less common for HIV tests and viral load supplies. Accessibility: Long distances to health centers was the top cited barrier to HIV testing and ART. Linkage to care was high overall (4,692 positive tests; 4,354 ART initiations), but was lower among key and vulnerable populations, and countries without test-and-treat. Among 81,817 people on ART, 16,491 viral load tests were performed. Acceptability: A third of participants rated the quality of services a 3 or less out of 5. A quarter of viral load test results were returned within two weeks, with faster turnaround time associated with improved viral suppression (p< .05). Affordability: Payment was not cited as a major barrier to services. Appropriateness: Key and vulnerable populations made up 16% of positive tests but just 7% of people on ART. Young men were less likely to access services than young women.
Conclusions: To achieve the 90-90-90 targets, ongoing community monitoring is critical. The RCTO-WA highlights key access gaps along the HIV treatment cascade. National and regional advocacy should focus on expanding differentiated service delivery and removing gender- and human rights-related barriers.

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