BACKGROUND: The Medical Research Foundation (MRF) is the largest HIV treatment facility in Trinidad and Tobago reporting over 9,000 patients ever linked to care. Beginning in 2017, the MRF achieved clinical success and expanded ART coverage, accounting for 75% of all persons on ART nationally. During the third week of March, the MRF implemented five complementary models of differentiated care to ensure the continuity of ART services during stay-at-home measures mandated by government to avert community spread of COVID-19 infections.
DESCRIPTION: By the third week in March (2020), the MRF implemented five complementary models of differentiated care to include (1) Modified appointment spacing facilitated through multi-month ART prescriptions; (2) ART delivery services facilitated by community groups (3) A rapid clinic triage offering fast track refills; (4) Expanded patient tracing to track missed ART pick-ups and; (5) a dedicated phone line to provide psycho-social support for ART adherence. Data extracted from electronic patient records, call logs, and ART registries were collated and analysed to identify specific program gaps and barriers to patient retention on ART. Data was dis-aggregated to identify outcomes for sub populations.
LESSONS LEARNED: Data for January to March quarter showed 4,922 patients retained on ART, a 5% decrease from previous quarter (Sept 'Dec 2019) . There was a 29% decrease in ART retention among Men who have sex with men (MSM) during January to March compared to the previous quarter. Data extracted from call logs showed an increase in missed appointments and patients reporting fears of the spread of COVID-19 infections and their HIV status. Other barriers included, transportation costs of attending clinic, and being too busy to attend scheduled ART picks. This data was subsequently used to develop and tailor five complementary models of differentiated care to address program gaps and patient specific barriers. Early program data results show a 15% increase in the number of prescriptions dispensed, and an increase in scheduled ART visits in April (once month after program implementation).
CONCLUSIONS: The use of data to plan, implement, and monitor innovative models of differentiated care provide important lessons for HIV programs in maintaining gains in ART retention during the COVID-19 pandemic.