Abstract

Silver linings: how COVID-19 expedited differentiated service delivery for HIV.

Highlights

  • “In the rush to return to normal, use this time to consider which parts of normal are worth rushing back to.”

  • As we write this Editorial at the beginning of July 2021, the World Health Organization (WHO) has reported that the African continent is experiencing its worst week of the COVID-19 pandemic and that COVID-19 cases are rising in all six of the WHO’s global regions [1, 2]

  • There is a serious imbalance in global distribution of COVID-19 vaccines with only 1% of people in Africa and low-income countries being fully vaccinated and 85% of doses globally having been administered in high- and upper-middle-income countries [1, 3]

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Summary

Extended ART refill durations should be a new standard of care

Perhaps the most consistent innovation recommended for HIV services during COVID-19 has been to increase access to and duration of multi-month dispensing (MMD) of ART refills [18,19,20]. Of five models that were implemented, more than half of all clients referred participated in a community ART refill club (53%) and the largest increase in enrolment corresponded with the first COVID-19 wave in Nigeria. A pilot of home delivery through a courier service found that 84% of clients accepted home delivery with 91% of ART refills successfully delivered. Both prospective users and private pharmacies were approached in assessing the feasibility of ART refills from private pharmacies; 61% of the prospective users indicated interest and willingness to pay approximately USD$4/refill for two refills per year

DSD for HIV is also relevant in more highly resourced settings
Findings
DSD is applicable for HIV prevention and tuberculosis treatment
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