Multimonth Dispensing of Antiretroviral Therapy Protects the Most Vulnerable From 2 Pandemics at Once

Abstract

Multimonth dispensing, which provides patients with several months of antiretroviral therapy, benefits HIV patients by decreasing the number of required clinic visits, improving retention, and improving viral suppression.n With the increased spread of severe acute respiratory syndrome coronavirus 2, we encourage governments, ministries of health, and health care facilities to implement multimonth dispensing for patients with HIV who are stable to reduce clinic visits and safeguard both health care workers and patients from coronavirus disease 2019.

Evaluation of HIV treatment outcomes with reduced frequency of clinical encounters and antiretroviral treatment refills: A systematic review and meta-analysis

“…While we found overall little difference in clinical outcomes for reduced visit frequency, there are other potential benefits of reduced visits, including decongestion of health facilities, reduced provider workload, prioritization of care for new or clinically unstable PLWH, and reduced transmission of COVID-19 in health centers [ 5 , 13 , 41 – 44 ]. Reducing visit frequency has been reported to be one of the easiest DSD models to implement and aligns strongly with the care preferences of PLWH by reducing the economic costs of attending frequent appointments, reducing stigma, and allowing PLWH to normalize HIV [ 3 , 4 , 10 , 11 , 45 , 46 ].…”

HIV viral load suppression before and after COVID-19 in Kinshasa and Haut Katanga, Democratic Republic of the Congo

“…15 The possible factors that could have affected these findings include: (1) the governmental COVID-19 lockdowns and restrictions, which affected the movement of the population within the country and provinces, 9,12 thus potentially keeping the patients closer to the HIV clinics; (2) the change in the differentiated care models for ART that allowed for patients who would not have initially met MMP and MMD criteria to have access to these, which allowed patients aged 2-13 years old to have access to MMD-3 and those 14 years and older to have access to MMD-6. 22,23,24 While the exact reasons for the difference cannot be fully analysed with the existing data, this finding holds promise for the ability of healthcare organisations to achieve favourable HIVrelated outcomes in the face of emergencies and other events that could have adverse impacts on health systems.…”

How Home Delivery of Antiretroviral Drugs Ensured Uninterrupted HIV Treatment During COVID-19: Experiences From Indonesia, Laos, Nepal, and Nigeria

“…[19][20][21] Clients typically receive medication supplies lasting between 3 and 6 months through an approach known as multimonth dispensing (MMD). 22 They are required to return to the health facility periodically for a clinical consultation (typically every 12 months) and viral load sample collection (Table ). The COVID-19 pandemic has evoked calls for countries to accelerate the formulation of policies and implementation strategies supportive of both DSD 23 and MMD 22 that reduce the frequency of contact between health care workers and PLHIV, thereby reducing both bidirectional risks of SARS-CoV-2 transmission and burden on the health care system.…”

“… 22 They are required to return to the health facility periodically for a clinical consultation (typically every 12 months) and viral load sample collection ( Table ). The COVID-19 pandemic has evoked calls for countries to accelerate the formulation of policies and implementation strategies supportive of both DSD 23 and MMD 22 that reduce the frequency of contact between health care workers and PLHIV, thereby reducing both bidirectional risks of SARS-CoV-2 transmission and burden on the health care system. Some approaches leverage the private sector through decentralized drug distribution through private pharmacies or automated dispensing.…”