PEPFAR’s response to the convergence of the HIV and COVID‐19 pandemics in Sub‐Saharan Africa

Abstract

Introduction The COVID‐19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID‐19 preparedness and response plans were rapidly instituted across sub‐Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID‐19 pandemic would have in under‐resourced settings with high burdens of PLHIV. The potential negative impact of COVID‐19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID‐19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID‐19‐related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID‐19. This commentary reviews PEPFAR’s COVID‐19 technical guidance and provides country‐specific examples of programme adaptions in sub‐Saharan Africa. Discussion The COVID‐19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over‐burdened health systems. Although there is currently limited understanding of how COVID‐19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID‐19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in‐person home and facility visits and other direct contact when COVID‐19 control measures are in effect. PEPFAR‐supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID‐19 in sub‐Saharan Africa. Conclusions As community transmission of COVID‐19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data‐driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID‐19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.

COVID-19 and the health of people who use drugs: What is and what could be?

“…An additional concern is how exposure to COVID-19 among people who use drugs exacerbates co-occurring invasive bacterial infections, particularly community-acquired pneumonia and infective endocarditis ( Jacka, et al, 2020 ). We note the need to better understand, as well as address, how COVID-19 entangles with other viral infections, especially HIV ( Golin et al, 2020 , Vasylyeva et al, 2020 , Wilkinson and Grimsrud, 2020 ) and HCV ( Blach et al, 2020 , Karimi-Sari and Rezaee-Zavareh, 2020 ). A concern here is how COVID-19 responses stretch the already limited resources available in some settings to maintain the scale-up of prevention and treatment required across multiple viral infections affecting people who use drugs, risking the disruption or slowing of progress towards achieving viral elimination targets in relation to HIV ( Golin et al, 2020 , Wilkinson and Grimsrud, 2020 ) and HCV ( Blach et al, 2020 , Karimi-Sari and Rezaee-Zavareh, 2020 ).…”

COVID-19 Infection among People with HIV/AIDS in Africa: Knowledge Gaps, Public Health Preparedness and Research Priorities

“…While the African Union (AU) and the Africa Centers for Disease Control and Prevention (Africa CDC) have continued to spearhead and coordinate the continent’s COVID-19 prevention strategy, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has focused on integrating HIV/AIDS prevention and management with COVID-19 management in the region. 22 Recognizing the importance of an integrated COVID-19/HIV service delivery, the Africa CDC in response created a webinar series on maintaining HIV & TB testing in the context of COVID-19 infection to train health care workers in the early stage of the outbreak in April 2020. 23 However, Africa’s health system is markedly under-resourced with numerous African countries ranking low in key health system capacity indicators such as ratio of health care workers, and hospital facilities per patient.…”

A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda

“…These data are essential to inform decision making by national-level HIV program managers, funders, providers and frontline health workers in countries rolling out DARTS [13]. Additionally, DSD has gained an increased importance in the context of the Covid-19 pandemic with a number of countries leveraging these models to deliver six-month ART re lls to patients held up by 'lockdown' measures for averting spread of Covid-19 [33,34]. Several studies have called for assessments of the uptake of DSD in countries implementing national scale-up programs [1,5,11,12].…”