Maintaining HIV services in the context of COVID-19 pandemic in Nampula province, Mozambique

BACKGROUND: After the first COVID-19 case in Mozambique, the government instituted a State of Emergency between April'September 2020. To reduce exposure for people living with HIV (PLHIV), the Ministry of Health modified service delivery guidance, interrupting community activities, revising patient flow within health facilities (HFs), and simplifying criteria for differentiated service delivery (DSD). ICAP supported the Nampula Provincial Health Services to ensure continuation of HIV service delivery at 59 supported HFs.
DESCRIPTION: Since April 2020, ICAP implemented a package of interventions to increase COVID-19 knowledge, reduce transmission, and ensure continuous essential care for PLHIV, including: development/dissemination of COVID-19 prevention radio spots; prevention talks by lay staff in HF waiting areas; infection prevention measures; phone-based outreach to index patients inviting contacts for HIV testing; one-stop models for HIV services; phone-based adherence counseling using targeted scripts; daily review of patient files to identify and transition eligible patients to three-month drug distribution (3MDD). In June 2020, ICAP launched community-based HIV service delivery using mobile clinics and brigades based at 12 HFs, expanding to 16 HFs and 5 key population hotspots in September 2020. ICAP and HF teams reviewed HIV cascade data by subpopulation weekly to identify/address gaps.
LESSONS LEARNED: Monthly HF attendance decreased by 37% between March (430,435) and September (270,547) as COVID-19 cases increased. The number of PLHIV on treatment in Nampula continued to increase, however, from 83,847 (Q2, January'March) pre-pandemic to 90,094 (Q3, April'June) at the start of the pandemic and 99,048 (Q4, July'September) later on. Patients in DSD models increased 101% Q3-Q4 (46,676 to 93,630), with 3MDD increasing 155% (24,648 to 62,931). Despite declines in testing and linkage indicators in Nampula between Q2-Q3, indicators improved by Q4. HIV testing decreased 8% from Q2 (131,228) to Q3 (120,749) but increased 13% by Q4 (136,104). Positive tests increased 22% between Q2-Q3 (7,141 to 8,739). Individuals newly initiating ART decreased 12% from Q2-Q3 (8,228 to 7,239) but increased 21% in Q4 (8,777).
CONCLUSIONS: Innovative approaches to service delivery, including phone-based outreach, expansion of multi-month distribution and community-based service delivery, were key to maintaining PLHIV in care and continuing service provision throughout the COVID-19 pandemic.