Impact of virtual follow-up and six-month dispensing on viral suppression and loss to follow-up (LTFU) during COVID-19 in the Democratic Republic of the Congo (DRC)

BACKGROUND: In the DRC, COVID-19 related restrictions and fear decreased access to and use of facility-based HIV services. To maintain access to antiretroviral treatment (ART), the Integrated HIV/AIDS Project in Haut-Katanga (IHAP-HK) rapidly pivoted to six-month dispensing and intensified enrollment in adapted differentiated service delivery models, including community-based ART distribution points (PoDi+). Our analysis aims to measure the impact of adaptations to our PoDi+ model on clients' viral suppression and LTFU.
METHODS: IHAP-HK established the PoDi+ model in 2016, under which ART refills, adherence counseling, and nutritional and TB screenings are provided at a community site. During COVID-19, IHAP-HK adapted the model to integrate appointment reminders; institute monthly virtual adherence and health checks between appointments; and shift eligible clients from three- to six-month ART dispensing. We analyzed programmatic data across three PoDi+ sites from inception through December 2020, using last VL and LTFU rates to assess the impact of COVID-related PoDi+ adaptations on LTFU and viral suppression (<1000 copies/mL) before and during COVID-19. We used descriptive statistics to describe population characteristics, and multivariate logistic regression to assess the association between viral suppression and the pre-COVID-19 (through February 2020) and during COVID-19 (March'December 2020) periods, controlling for sex, age at ART initiation, and months on ART.
RESULTS: A total of 2,370 clients (69% female; 21% of clients enrolled after March 2020) were included in the overall analysis. 45 clients were LFTU during the analysis period, with a greater LTFU rate before COVID-19 (0.77/100 person-years [PY]) than during COVID 19 (0.2/100 PY; IRR = 3.15 95% CI: 1.59'6.22). Of the 1,379 clients with a current VL count, viral suppression was greater among clients who had their last VL result during COVID-19 (676/752; 95% suppression) than those before COVID-19 (596/627; 90% suppression) (OR = 7.63 95% CI: 4.12'14.12).
CONCLUSIONS: IHAP-HK's adapted PoDi+ model yielded higher viral suppression and reduced LTFU among PoDi+ clients, highlighting its success in minimizing COVID-19's impact on treatment outcomes. Scaling and sustaining these client-focused adaptations are critical for promoting long-term treatment access and viral suppression to enable achievement of epidemic control targets.