Rapid scale-up of multi-month dispensation of antiretroviral therapy as a COVID-19 mitigation measure, Zambia, 2020


BACKGROUND: As a strategy to protect persons living with HIV (PLHIV) from COVID-19 infections by minimizing the number of clinical encounters, the Zambia national HIV program scaled up 6-month multi-month dispensation (6MMD) of antiretroviral therapy (ART). Due to global supply chain disruptions related to the COVID-19 pandemic, however, there was inadequate stock of first-line ART, Tenofovir-Lamivudine-Dolutegravir (TLD), to implement 6MMD among all PLHIV on TLD. As an alternative, there was adequate existing stock of Tenofovir-Lamivudine-Efavirenz (TLE) to provide 6MMD to eligible PLHIV, so patients on TLD were switched to TLE to receive 6MMD. We describe the experience of scaling up 6MMD among PLHIV in Zambia in response to the COVID-19 pandemic and its impact on retention.
METHODS: Using de-identified patient-level data from electronic medical records, we analyzed the proportions of PLHIV (>15 years old) on ART who received 6MMD by March 31 2020 compared with September 30 2020, as well as changes to ART regimens and lost-to-follow-up rates (LTFU), defined as the number of patients who are >30 days late to their next scheduled appointment on a given date divided by the sum of lost patients and the number of patients currently on ART.
RESULTS: In March, 376,220 (37.8%) of PLHIV on treatment were receiving 6MMD and by the end of September, 573,614 (56.2%) were receiving 6MMD. Of those on 6MMD at the end of September, 330,315 (57.6%) were on TLE while 158,041 (27.6%) were on TLD, in comparison with 148,948 (39.6%) on TLE and 180,667 (48.0%) on TLD in March. Overall LTFU was 96,310 (9.7%) in March compared with 68,227 (6.7%) in September.
CONCLUSIONS: The Zambia national HIV program successfully implemented rapid scale-up of 6MMD as a strategy to protect PLHIV from potential COVID-19 exposures at health facilities. This rapid scale-up was possible despite supply chain disruptions related to the pandemic because of the country's existing stock of TLE. Scale up of 6MMD aligned with an improvement in LTFU rates, supporting its role in improving retention. Now that the country has adequate stock levels of TLD, patients are being transitioned back to TLD.