The impact of the COVID-19 pandemic on uptake of multi-month dispensing (MMD) of antiretroviral therapy for children living with HIV: a multicountry analysis



Uptake of multi-month dispensing (MMD) of antiretroviral therapy (ART) for stable children (<15 years old (y/o)) living with HIV (CLHIV) varied widely across countries prior to the COVID-19 pandemic. COVID-19 prompted efforts to rapidly decongest health facilities to prevent transmission. This analysis updates a 2020 International Pediatrics Workshop oral presentation on MMD services changes for CLHIV during COVID-19.


MMD uptake among CLHIV in 12 USAID/PEPFAR-supported countries from October 1, 2019 to September 30, 2020 (Fiscal Year 20 quarter (Q) 1 to Q4) was analyzed using implementing partner and program data. Q1 and Q2 data was averaged (Q1/2) to represent pre-COVID-19 results; Q3 and Q4 data represented results during quarters with COVID-19-related-restrictions. Chi-square tests compared results from pre-COVID-19 to during COVID-19 (Q1/2 to Q3; Q1/2 to Q4), and compared changes during COVID-19 (Q3 to Q4). MMD was defined as dispensing ART at intervals of <3 months (<3MMD), 3-5 months (3-5MMD), or 'ยง6 months (6MMD).

RESULTS: From Q1/2 to Q4, the total number of CLHIV on treatment increased from 178,820 to 185,357 (Table 1). The percentage of CLHIV receiving any MMD (3-5MMD or 6MMD) increased from 36.9% (Q1/2) to 54.8% (Q4). The percentage of CLHIV receiving <3MMD decreased from 63.1% (Q1/2) to 45.2% (Q4). The 3-5MMD coverage increased from 34.2% (Q1/2) to 47.6% (Q3); despite a slight decrease to 45.9% in Q4 there remained an overall increase from Q1/2 to Q4. The percentage of CLHIV receiving 6MMD increased steadily from 2.7% in Q1/2 to 6.1% in Q3 to 9.0% in Q4. All changes from Q1/2 to Q3 and Q4, and Q3 to Q4 were statistically significant (p<0.001).


MMD uptake among CLHIV on ART increased significantly during the COVID-19 pandemic. Continued expansion of MMD policies and uptake, even as COVID-19-related restrictions relax, will strengthen access to ART for CLHIV.