The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings

Collins, Lauren F; Colasanti, Jonathan; Nguyen, Minh Ly; Moran, Caitlin; Lahiri, Cecile D.; Marconi, Vince C; Armstrong, Wendy S.; Shah, N Sarita

doi:10.1097/qad.0000000000002746

Cited by 18 publications

(19 citation statements)

References 26 publications

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“…This raises concern around the effects of Covid-19 prevention measures on ART adherence at the individuallevel and impacts on viral suppression at the populationlevel [52]. This calls for further research to understand the impacts of Covid-19 on viral suppression in Ugandan patients especially those utilizing longitudinal data with a retrospective lens [48,53].…”

Section: Discussionmentioning

confidence: 99%

“…However, supply chain capacities need to be strengthened in Uganda to enable implementation at the facility-level to reduce stock-out events [ 41 , 47 ]. This may require national-level process re-engineering of supply chains such as bolstering storage capacities [ 39 ], restructuring from a bi-monthly order cycle to an architecture that supports multi month dispensing [ 48 ]. In this study we found that providers who implemented six month dispensing without strengthened supply chain capacity, inadvertently contributed to stock-out events that negatively impacted the stock of ART commodities available to the broader base of patients.…”

Section: Discussionmentioning

confidence: 99%

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Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

Zakumumpa

Tumwine

Milliam

et al. 2021

BMC Health Serv Res

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Background The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. Methods We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach. Results Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. Conclusion While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

Zakumumpa

Tumwine

Milliam

et al. 2021

BMC Health Serv Res

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“…DSD empowers PLHIV to find a model of care conducive to their lifestyle while decongesting the healthcare system [27].…”

Section: Discussionmentioning

confidence: 99%

Distribution of antiretroviral therapy through private pharmacies and postal courier services during COVID‐19 in Botswana: acceptability and reach of two out‐of‐facility individual differentiated service delivery models

et al. 2021

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IntroductionThe advent of COVID‐19 has put pressure on health systems as they implement measures to reduce the risk of transmission to people living with HIV (PLHIV) and healthcare workers. For two out‐of‐facility individual differentiated service delivery (DSD) models, we assessed acceptability of antiretroviral therapy (ART) distribution through private pharmacies and reach of home delivery of ART through courier services during the COVID‐19 pandemic in Botswana.MethodsFrom 24 July to 24 August 2020, we conducted exit interviews with PLHIV receiving ART from 10 high‐volume public facilities in Gaborone, and mapped and conducted an online survey with private pharmacies to assess willingness and capacity to dispense ART to PLHIV enrolled in the Botswana national ART program. We piloted ART home delivery from September 2020 to January 2021 in Gaborone and Kweneng East districts for PLHIV accessing ART at two Tebelopele Wellness Clinics. We used cascade analysis to measure the enrolment and eventual reach (percentage of those reached amongst those who are eligible) of ART home delivery.ResultsSixty‐one PLHIV and 42 private pharmacies participated. Of the PLHIV interviewed, 37 (61%) indicated willingness to access ART from private pharmacies and pay BWP50 (∼US$4) per refill for a maximum of two refills per year. All private pharmacies surveyed were willing to provide ART, and 26 (62%) would charge a dispensing fee (range = BWP50–100; ∼US$4–8) per refill. All pharmacies operated 12 h/day, 6 days/week and on public holidays. In the home delivery pilot, 650 PLHIV were due for refills, 69.5% (n = 452) of whom were eligible for home delivery. Of these, 361 were successfully offered home delivery and 303 enrolled (enrolment = 83.9%: female = 87.2%, male = 77.8%, p = 0.013). A total of 276 deliveries were made, a reach of 61%.ConclusionsProviding ART through private pharmacies and home delivery was acceptable in Botswana during COVID‐19. Surveyed pharmacies were willing and able to dispense ART to PLHIV attending public sector facilities for free or for a nominal fee. Additionally, using courier services for ART home delivery is a novel and viable model in countries with a reliable courier service like Botswana and should be scaled up, particularly in urban areas.

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“…The VA benefits from one of the most highly developed health information systems in the world [ 1 ] and is one of the first US healthcare systems to create extensive virtual healthcare infrastructure including telephone and video visits (henceforth referred to as “virtual”) [ 2 , 3 ]. With the emergence of the COVID‐19 pandemic, changes in healthcare delivery became immediately necessary [ 4 , 5 ], and the VA responded quickly by expanding virtual care [ 2 , 6 , 7 , 8 , 9 , 10 ]. On 19 March 2020, the VA issued guidance for “Alternative Telehealth Communication Technologies During COVID19 National Emergency” [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Understanding how the pandemic has impacted HIV healthcare service utilization, ARV adherence and substance use disorder screening can inform efforts to maintain continuity of care for PWH and other chronic health conditions using differentiated service delivery. More specifically, examining the impact of healthcare changes for PWH may provide broader insights into the implications of virtual care models for other chronic diseases as well as for maximizing healthcare resources and/or helping overcome barriers to care such as distance to clinic and/or lack of mobility or transportation [ 5 ]. Our main goals were to compare among PWH during and prior to the COVID‐19 pandemic: (1) HIV healthcare delivery and (2) frequency of alcohol and tobacco use screening.…”

Section: Introductionmentioning

confidence: 99%

HIV care using differentiated service delivery during the COVID‐19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs

et al. 2021

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IntroductionThe Department of Veterans Affairs (VA) is the largest provider of HIV care in the United States. Changes in healthcare delivery became necessary with the COVID‐19 pandemic. We compared HIV healthcare delivery during the first year of the COVID‐19 pandemic to a prior similar calendar period.MethodsWe included 27,674 people with HIV (PWH) enrolled in the Veterans Aging Cohort Study prior to 1 March 2019, with ≥1 healthcare encounter from 1 March 2019 to 29 February 2020 (2019) and/or 1 March 2020 to 28 February 2021 (2020). We counted monthly general medicine/infectious disease (GM/ID) clinic visits and HIV‐1 RNA viral load (VL) tests. We determined the percentage with ≥1 clinic visit (in‐person vs. telephone/video [virtual]) and ≥1 VL test (detectable vs. suppressed) for 2019 and 2020. Using pharmacy records, we summarized antiretroviral (ARV) medication refill length (<90 vs. ≥90 days) and monthly ARV coverage.ResultsMost patients had ≥1 GM/ID visit in 2019 (96%) and 2020 (95%). For 2019, 27% of visits were virtual compared to 64% in 2020. In 2019, 82% had VL measured compared to 74% in 2020. Of those with VL measured, 92% and 91% had suppressed VL in 2019 and 2020. ARV refills for ≥90 days increased from 39% in 2019 to 51% in 2020. ARV coverage was similar for all months of 2019 and 2020 ranging from 76% to 80% except for March 2019 (72%). Women were less likely than men to be on ARVs or to have a VL test in both years.ConclusionsDuring the COVID‐19 pandemic, the VA increased the use of virtual visits and longer ARV refills, while maintaining a high percentage of patients with suppressed VL among those with VL measured. Despite decreased in‐person services during the pandemic, access to ARVs was not disrupted. More follow‐up time is needed to determine whether overall health was impacted by the use of differentiated service delivery and to evaluate whether a long‐term shift to increased virtual healthcare could be beneficial, particularly for PWH in rural areas or with transportation barriers. Programmes to increase ARV use and VL testing for women are needed.

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The COVID-19 pandemic as a catalyst for differentiated care models to end the HIV epidemic in the United States: applying lessons from high-burden settings

Cited by 18 publications

References 26 publications

Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

Distribution of antiretroviral therapy through private pharmacies and postal courier services during COVID‐19 in Botswana: acceptability and reach of two out‐of‐facility individual differentiated service delivery models

HIV care using differentiated service delivery during the COVID‐19 pandemic: a nationwide cohort study in the US Department of Veterans Affairs

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