When Agnes Akou learned she was HIV-positive, she became so worried people would find out that she considered ending her life. It remained her secret as she sought treatment. “My three grown-up children do not know I am HIV-positive,” she confided during a support group meeting. “I can’t tell them.”

Côte d’Ivoire has the highest prevalence of HIV in West Africa. HIV/AIDS is the leading cause of death among adult males and the second leading cause of death among women in Côte d’Ivoire. More than 500,000 people have been diagnosed with HIV, and stigma remains high, keeping many people from seeking treatment.

Although the Government of Côte d’Ivoire has made substantial progress in the past decade in taming the HIV epidemic, many people living with HIV still are not on antiretroviral therapy (ART). Moreover, there are high rates of clients dropping out of treatment and low adherence to ART.

To encourage patient acceptance and increase linkage to ART care, retention and adherence, PEPFAR, the US Centers for Disease Control and Prevention, and Jhpiego partnered with the Ministry of Health and Public Hygiene on an integrated, comprehensive, client-focused primary health care project in two regions in central and southwest Côte d’Ivoire.

Co-designed by national and local stakeholders, and overseen by regional and district health management teams, the Jhpiego-led integrated chronic care model project helped the Centre de Santé Urbain Confessionel Hospital in Dimbokro and 43 other health facilities to restructure the way services were delivered. Instead of standalone HIV care and treatment outlets, these “health clubs” work to integrate HIV as a chronic disease and offer services similar to those for other manageable diseases, such as diabetes, TB and hypertension. To ensure that providers had the required skills, the project trained midwives and nurses in participating facilities to competently and confidently offer comprehensive services, a key pillar of primary health care delivery.

These nurses and midwives learned how best to deliver care for TB, hypertension and diabetes, including initiation of first-line ART regimens, monitoring of drug side effects, and referral of cases to physicians at higher-level facilities and support services.

The health clubs provide clients with essential information, medicine and services, allowing for a member-focused, strong, sustainable and community-owned approach.

To help Akou and other clients stay on their medicine and keep their health appointments, the project recruited community health workers like Kouadio Konan to follow client progress and bring friendly HIV and chronic care services closer to people’s homes. Konan, 48, oversees 92 clients in his village of Tano Akakro in Djangokro, where he organizes at least two health club meetings per month.

When I met the health club members the first time I was introduced and found out that some of the patients [in the club] were HIV-positive but doing well, I was very encouraged. I realized I was not alone, and that I can also be well, just like them.Agnes Akou

He also maintains a community register with details of his clients and their drugs, and counts remaining pills during home visits to check adherence. It was during a home visit that Konan noticed 65-year-old Loukou Kouamé wasn’t taking his medicine regularly. His bottle of antiretroviral drugs was always full, his health worsening.

“I had lost hope. I had given up,” said Kouamé, a member of a health club located at the health center in Djangokro. But Konan didn’t give up on Kouamé. “Thanks to community health workers and the health club for helping me get my strength back, I am [now] doing well,” said Kouamé, who feels well enough to support his family again.

For Akou, she is hopeful that one day she will be able to tell her three children, “I have HIV,” and be accepted for who she is, just like patients with TB, hypertension and diabetes.