BACKGROUND: Countries around the world have launched less-intensive treatment models for people living with HIV (PLHIV) doing well on antiretroviral therapy (ART). These differentiated service delivery (DSD) approaches include both facility and community-based individual and group models. The HIV Coverage, Quality, and Impact Network (CQUIN) is a south-to-south learning network of 14 countries in sub-Saharan Africa (SSA) designed to foster the implementation of high quality DSD at scale. In April 2020, CQUIN conducted a rapid survey to understand the impact of the COVID-19 pandemic on DSD policy and implementation in the first weeks of the pandemic response.
DESCRIPTION: CQUIN supports a community of practice of National DSD Coordinators from each network country. These 14 experts, situated at Ministries of Health, communicate regularly, virtually and in person. On April 3, we circulated questions about changes to the national HIV-DSD program response. The Coordinators reviewed and confirmed the policy changes the week of April 13 and updated results the week of May 4.
LESSONS LEARNED: Within weeks of the first reports of COVID-19 in SSA, all 14 countries made substantive changes to their national DSD programs. Aiming to protect PLHIV and health care workers and enhance program resilience, the most common adaptation was the expansion of multi-month dispensing (MMD) to decrease health facility visit frequency. Ten countries expanded MMD eligibility, including four that waived requirements for HIV viral load suppression for people on ART, six that newly permitted MMD for people initiating ART, and three that newly included pregnant/breast-feeding women and virally suppressed children above 2 years. Seven countries increased the amount of ART dispensed via MMD and nine enabled MMD of tuberculosis preventive treatment. Other changes included canceling or redesigning group models to enhance social distancing. Eight countries canceled > 1 model, including facility-based groups and Teen Clubs. Countries also expanded clinic hours, enhanced Fast Track service, and expanded community- and home-based drug delivery.
CONCLUSIONS: COVID-19 spurred rapid changes in the design and delivery of HIV treatment amongst countries in the CQUIN network, which were able to leverage experience with less-intensive DSD models, MMD, and community-based treatment strategies to swiftly adapt their HIV treatment programs.