Abstract
BackgroundTo accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February–September 2020.MethodsAdapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3–6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring.ResultsDuring February–September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%.ConclusionsA rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic.
Highlights
To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Pre‐ vention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART
Using dashboard data collected during April–September 2020, we examined the number of PLHIV initiating ART each month with an ART “starter pack” of fewer than 90 daily doses or at least 90 daily doses
The monthly total number of new ART initiations across April and May was relatively flat, and these achievements coincided in time with introduction and maintenance of COVID-19-related limitations on travel by Nigeria state governments
Summary
To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Pre‐ vention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020 To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February–September 2020. To overcome disruption of the ART Surge, CDC Nigeria staff developed and implemented a series of adapted strategies for all PLHIV populations in the nine focus states during February–September 2020 In developing these strategies, we hypothesized that if HIV testing and ART delivery within the ART Surge could be provided more widely in community settings, the number of PLHIV diagnosed and retained in treatment could be maintained or increased. We describe how virtual community health engagement and health system infrastructure of the ART Surge facilitated COVID-19 mitigation efforts in Nigeria
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