Background: Differentiated service delivery (DSD) models aim to lessen the burden of HIV treatment on patients and providers in part by reducing requirements for facility visits and extending dispensing intervals. With the advent of the COVID-19 pandemic, minimizing patient contact with healthcare facilities and other patients, while maintaining treatment continuity and avoiding loss to care, has become more urgent, resulting in efforts to increase DSD uptake. We assessed the extent to which DSD coverage and antiretroviral treatment (ART) dispensing intervals have changed during the COVID-19 pandemic in Zambia. Methods: We used patient data from Zambia's electronic medical record system (SmartCare) for 737 health facilities, representing about 3/4 of all ART patients nationally, to compare the numbers and proportional distributions of patients enrolled in DSD models in the six months before and six months after the first case of COVID-19 was diagnosed in Zambia in March 2020. Segmented linear regression was used to determine whether the introduction of COVID-19 into Zambia further accelerated the increase in DSD scale-up. Results: Between September 2019 and August 2020, 181,317 patients aged 15+ (81,520 and 99,797 from September 1, 2019 to March 1, 2020 and from March 1 to August 31, 2020, respectively) enrolled in DSD models in Zambia. Overall participation in all DSD models increased over the study period, but uptake varied by model. The rate of acceleration increased in the second period for home ART delivery (152%), 0-2-month fast-track (143%), and 3-month MMD (139%). There were significant decelerations in the increase in enrolment for 4-6-month fast-track (-28%) and 'other' models (-19%). Conclusions: Participation in DSD models for stable ART patients in Zambia increased after the advent of COVID-19, but dispensing intervals diminished. Eliminating obstacles to longer dispensing intervals, including those related to supply chain management, should be prioritized to achieve the expected benefits of DSD models and minimize COVID-19 risk.
1Viruses in the family Partitiviridae consist of non-enveloped viruses with bisegmented double-2 stranded RNA genomes. Viruses in this family have been identified from plants and fungi. In 3 this study, we identified several viruses belonging to the family Partitiviridae using plant 4 transcriptomes. From 11 different plant species, we identified a total of 74 RNA segments 5 representing 23 partitiviruses. Of 74 RNA segments, 28 RNA segments encode RNA-6 dependent RNA polymerases (RdRp) while 46 RNA segments encode coat proteins (CPs). 7According to ICTV demarcation for the family Partitiviridae, 25 RNAs encoding RdRp and 8 41 RNAs encoding CP were novel RNA segments. In addition, we identified eight RNA 9 segments (three for RdRp and five for CP) belonging to the known partitivruses. Taken together, 10 this study provides the largest number of partitiviruses from plant transcriptomes in a single 11 study. Viruses in the family Partitiviridae consist of non-enveloped viruses with bisegmented double-2 stranded (ds) RNA genomes [1]. Each RNA segment of the viruses in the family Partitiviridae 3 encodes a single protein including RNA-dependent RNA polymerase (RdRp) or coat protein 4 (CP). Members in the family Partitiviridae can be divided into five different genera according 5 to the host. For example, viruses in the genera Alphapartitivirus and Betapartitivirus are 6 identified from either plants or fungi while viruses in the genus Gammapartitivirus and 7 Deltapartitivirus are derived from only fungi and plants, respectively [1]. In addition, viruses 8 in the genus Cryspovirus are identified from protozoa. Transmission of partitiviruses is 9 occurred by seeds (plants), cell division and sporogenesis (fungi), and oocytes (protozoa) [1]. 10 To date, there are more than 45 partitivirus species. In particular, there are five deltapartitivirus 11 species infecting plants including Pepper cryptic virus 1 (PCV-1) [2], Pepper cryptic virus 2 12 (PCV-2), Fig cryptic virus (FCV) [3], Beet cryptic virus 2 (BCV2), and Beet cryptic virus 3 13 (BCV3) [4] according to International Committee on Taxonomy of Viruses (ICTV). 14 To identify novel partitiviruses with dsRNA genomes, dsRNA extraction followed by 15 next-generation sequencing (NGS) is an efficient approach. Based on those approaches, several 16 partitiviruses have been identified. For example, Melon necrotic spot virus was identified from 17 watermelon plant (Citrullus lanatus Thunb) using SOLiD NGS analysis [5]. Pittosporum 18 cryptic virus 1 was identified from an Italian pittosporum plant by NGS with extracted dsRNA 19 [6]. Similarly, application of NGS to extracted dsRNA has resulted in identification of 20 Trichoderma atroviride partitivirus 1 from the fungal species Trichoderma atroviride [7]. 21 Moreover, instead of traditional molecular cloning methods, in silico data analyses has 22 resulted in identification of diverse dsRNA viruses from expressed sequence tag (EST) 23 database [8] and plant transcriptomes [9-13]. Moreover, 120 mycoviruses infecting fungi have...
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