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Scale-up of multi-month dispensation of antiretroviral therapy among children living with HIV as a COVID-19 mitigation measure and retention strategy, Zambia, 2020

Title
Scale-up of multi-month dispensation of antiretroviral therapy among children living with HIV as a COVID-19 mitigation measure and retention strategy, Zambia, 2020
Presenter
Megumi Itoh
Authors
M. Itoh * (1), A. Mwila (1), K. Musokotwane (1), M.A. Boyd (1), K. Mweebo (1), G. Sinyangwe (2), G. Lingenda (2), P. Ulaya (3), S. Fwoloshi (4), K. Zyambo (4), C. Chungu (5), P.L. Mulenga (4), S.A. Agolory (1).
Institutions
(1) Centers for Disease Control and Prevention, Lusaka, Zambia, (2) United States Agency for International Development, Lusaka, Zambia, (3) United States Department of Defense, Lusaka, Zambia, (4) Ministry of Health, Lusaka, Zambia, (5) Catholic Relief Services, FASTER Project, Lusaka, Zambia

BACKGROUND: Prior to the COVID-19 pandemic, children were not prioritized for multi-month dispensation (MMD) of antiretroviral therapy (ART) in Zambia. However, when the first cases of COVID-19 were reported in March 2020, the country's HIV program implemented scale-up of MMD as a mitigation strategy in April 2020 to prevent COVID-19 infections and treatment interruptions by minimizing clinical encounters among persons living with HIV (PLHIV), which included eligible children '¥2 years of age.
METHODS: Using de-identified patient-level data from electronic medical records, we analyzed the proportions of children living with HIV (CLHIV) <15 years on ART who were on minimum 3-month MMD (3MMD) from March to Sept 2020. Using program data, we also compared pediatric viral load coverage (VLC) and suppression (VLS) in Zambia between the same time periods. Lastly, we compared lost-to-follow-up (LTFU) rates of CLHIV among those receiving at minimum 3MMD vs. those on <3 months dispensation. LTFU rate is defined as the number of patients who are more than 30 days late to their next scheduled appointment (lost) on a given date divided by the sum of all patients (lost and current).
RESULTS: Prior to the first cases of COVID-19 in Zambia in March 2020, 20,727 (46.5%) of CLHIV were receiving minimum of 3MMD, compared to 27,028 (62.7%) at Oct 2020. Despite scale up of MMD and CLHIV coming less frequently to clinic appointments, VLC was not adversely affected, with 76% coverage in March compared to 78% in Sept 2020. VLS improved as well, with 79% suppressed in March compared to 84% in Sept 2020. Among those receiving at least 3MMD as of Sept 2020, LTFU rate was 5.0%, as compared to 17.4% among those who were not receiving MMD.
CONCLUSIONS: Scale-up of 3MMD among CLHIV '¥2 years of age had no adverse impact on their VLC or VLS. It appeared to be an important COVID-19 mitigation strategy that minimized the number of interactions with health facilities and decreased LTFU rates. Provision of 3MMD to CLHIV should be considered an integral retention strategy for the national pediatric HIV program and continue to be scaled up.