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Impact of COVID-19 on Elton John AIDS Foundation projects for key populations in Eastern Europe and Central Asia: adaptive strategies and lessons learned

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BACKGROUND: In 2020, the Elton John AIDS Foundation (EJAF) supported service-delivery projects for key populations (KPs) across nine Eastern Europe and Central Asia (EECA) countries. The COVID-19 pandemic posed significant risks to implementers' ability to maintain HIV prevention and care services for KPs, while presenting new economic, health and social challenges for project beneficiaries.
DESCRIPTION: To sustain supported interventions and adapt to new KP needs, EJAF, EECA's largest HIV philanthropic funder (FCAA,2020), worked with each implementing partner to reallocate resources and released additional funds for COVID-19 mitigation activities where most needed. EJAF's 'Lighthouse' projects in Russia's three largest cities (Moscow, St. Petersburg, Novosibirsk), which support NGO-led HIV service delivery for KPs in partnership with government HIV clinics from 2018-2021, showed that with effective re-programming, service coverage could be maintained and even increased. In March-November 2020, 'Lighthouses' provided outreach, testing, and linkage services to 25,310 KPs and their partners, 26% more than in the equivalent period in 2019.
Implementers across EECA adopted the following successful strategies: 1)COVID-19 personal protective equipment (PPE) to enable safe access to HIV services and enable mobility for most vulnerable KPs; 2)Increased gender-sensitive material support, including food, shelter and hygiene services, to respond to economic crisis for vulnerable KPs; 3)Innovative modalities, such as home-based HIV testing and on-line outreach; 4)Mobile ART dispensing to vulnerable PLHIV to ensure adherence.
LESSONS LEARNED: 1)Pre-COVID-19 investments in digital innovation paid off by allowing services to continue; 2)Amid COVID-19, KPs need basic life support to maintain demand for HIV services; 3)PPE enabled clients to maintain mobility in their communities, particularly where PPE is required but unaffordable; 4)Integrating COVID-19 and HIV prevention services allowed getting 'two birds with one stone', e.g. delivering masks alongside condoms; 5)COVID-19 has enabled some HIV-service improvement (e.g. home-based models), allowing projects to reach new KP sub-groups; (6)NGOs demonstrated their value-add and received pubic recognition from government partners amid restrictive civil society environment.
CONCLUSIONS: Despite challenges, implementing partners' strategic creativity enabled effective continuation and in some cases improvement of community-led HIV services. Implementing partners will continue best practices that improve accessibility and quality of HIV services beyond the COVID-19 pandemic.