Abstract
Faced with the coronavirus disease (COVID-19) pandemic, governments worldwide instituted lockdowns to curtail virus spread. Health facility closures and travel restrictions disrupted access to antiretroviral (ARV) therapy for people living with HIV. This report describes how HIV programs in Indonesia, Laos, Nepal, and Nigeria supported treatment continuation by introducing home delivery of ARVs. Staff supporting the programs provided accounts of when and how decisions were taken to support ARV home delivery. They captured programmatic information about home delivery implementation using an intervention documentation tool. The 4 country experiences revealed lessons learned about factors favoring successful expansion of ARV home delivery. Three of the countries relied on existing networks of community health workers for ARV delivery; the fourth country, Indonesia, relied on a private sector courier service. Across the 4 countries, between 19% and 51% of eligible clients were served by home delivery. The experiences showed that ARV home delivery is feasible and acceptable to health service providers, clients, and other stakeholders. Essential to success was rapid mobilization of stakeholders who led the design of the home delivery mechanisms and provided leadership support of the service innovations. Timely service adaptation was made possible by pre-existing differentiated models of care supportive of community-based ARV provision by outreach workers. Home delivery models prioritized protection of client confidentiality and prevention measures for COVID-19. Sustainability of the innovation depends on reinforcement of the commodity management infrastructure and investment in financing mechanisms. Home delivery of ARVs is a feasible client-centered approach to be included among the options for decentralized drug distribution. It serves as a measure for expanding access to care both when access to health services is disrupted and under routine circumstances.
Highlights
Faced with the coronavirus disease (COVID-19) pandemic, governments worldwide instituted lockdowns to curtail virus spread
Home Delivery of Antiretrovirals During COVID-19: 4 Countries’ Experiences www.ghspjournal.org antiretroviral therapy (ART) for people living with HIV (PLHIV).[3,4]
The home delivery model is a client-centered, community ART management program that improves the quality of life for PLHIV by providing a convenient means of uninterrupted access to ART
Summary
Governments worldwide rapidly instituted social distancing policies and lockdowns in 2020 to decrease the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19).[1,2] The restrictions disrupted routine health services, including initiation and continuation of. Between May and November 2020, 4,138 of the 8,136 (51%) clients on ART in Mbo LGA were receiving prepacked ARVs by home delivery, with overall client retention at 99% Reflecting on their experiences with patients who chose not to use home delivery, program implementers posited that this could be due to concerns about confidentiality, privacy, and stigma or to a preference for other DSD options that are www.ghspjournal.org convenient for them, such as fast track clinics or refill clubs. Programs can justify investment in all the supports required for home delivery by producing programmatic data and completing cost-effectiveness modeling showing that it is a valuable addition to www.ghspjournal.org the ARV refill options, contributing to increased retention of clients in care, a persistent challenge to national HIV programs.[37,38,39]
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