Expanding access to HIV services during the COVID-19 pandemic—Nigeria, 2020

Abstract

Background To 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. Methods Adapted 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. Results During 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%. Conclusions A 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.

Low-level viraemia among people living with HIV in Nigeria: a retrospective longitudinal cohort study

“…14 Since 2019, Nigeria concurrently increased ART coverage, scaled up use of dolutegravir-based regimens, and expanded viral load monitoring, even during the COVID-19 pandemic. 15 – 17 Under the National ART Guidelines, 14 viral load monitoring is recommended at 6 months and 12 months after ART initiation and annually thereafter. People with virological non-suppression (≥1000 copies per mL) should repeat viral load testing 3 months after enhanced adherence counselling; patients with at least two consecutive tests indicating virological non-suppression should be reviewed for an ART regimen switch.…”

Malaria, HIV and Malnutrition among Internally Displaced People in Mozambique During COVID-19 Pandemic: Results from a Community-Based Intervention

“…Nevertheless, a common finding in HIV projects among IDPs is that the absence of a structural service for HIV screening represents a major challenge for test delivery to all eligible people [ 30 ]. Thus, a reaction strategy to SARS-CoV2 outbreak, along with the implementation of COVID-19 mitigation initiatives, should entail the adaptation of existing services for delivering care for all the major causes of death and morbidity, including malnutrition and HIV-malaria coinfections [ 31 32 ].…”

Innovations, adaptations, and accelerations in the delivery of HIV services during COVID-19

“…Complementing published experiences, 6 , 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 data were shared on service disruptions and mitigations in relation to HIV testing, antiretroviral therapy (ART), viral load testing, viral load suppression, pre-exposure prophylaxis (PrEP), prevention of vertical transmission, and voluntary medical male circumcision. Under-recognised factors that restricted HIV service delivery included staff shortages from illness, staff redeployment towards COVID-19, disruptions of public transportation services to travel to health facilities, and use of health facilities as isolation centers.…”

“… 6 , 24 Data from Nigeria suggested that a focused effort on HIV testing and treatment, despite COVID-19, could result in rapid expansion of HIV testing and treatment. 14 , 25 Appropriately funded programmes, including those with important external funding, did better than programmes with less international support, particularly for key populations.…”