Expansion of multi-month dispensing of HIV antiretroviral medication in sub-Saharan Africa in the COVID-19 era


BACKGROUND: In response to the COVID-19 pandemic, many ministries of health moved quickly to avoid interruption of HIV treatment and decompress health facilities (HF) by expanding multi-month dispensing (MMD) of antiretroviral therapy (ART). In sub-Saharan Africa (SSA), countries leveraged their previous experience with differentiated service delivery to deliver MMD at HF and in the community. We reviewed MMD data across 7 countries in SSA to assess changes during the first wave of COVID-19.
METHODS: We examined aggregate data collected and reported quarterly between October 2019-September 2020 by 1084 HF supported by ICAP at Columbia University through the US President's Emergency Plan for AIDS Relief. This included 40 HF in Eswatini, 19 in Ethiopia, 59 in Mozambique, 547 in Zambia, 74 in Cameroon, 146 in Côte d'Ivoire, and 199 in Democratic Republic of Congo (DR Congo). Numbers and percent of recipients of care (ROC) receiving <3, 3-5, and 6+ months of ART were calculated for countries, by quarter (Figure 1).
RESULTS: Across the 7 countries, 434,665 ROC received ART during the first quarter (Q1) of the period; this increased to 498,005 by the final quarter (Q4). Overall, provision of 3-5 months of ART (3-5MMD) increased from 41.2% of ROC in Q1 to 55.3% in Q4 and provision of 6+ months of ARV (6-MMD) increased from 12.6% in Q1 to 27.4% in Q4. MMD increased in all countries. Large increases in 3-5MMD were observed in Cameroon (Q1:6.8%, Q4:60.2%), Côte d'Ivoire (Q1:17.2%, Q4:59.1%), DR Congo (Q1:35.5%, Q4:86.3%), Ethiopia (Q1:6.9%, Q4:52.9%), and Mozambique (Q1:28.4%, Q4:78.4%). Increases in 6-MMD were observed in Eswatini (Q1:1.2%, Q4:35.5%), Ethiopia (Q1:6.3%, Q4:38.8%), and Zambia (Q1:23.8%, Q4:46.7%), while Côte d'Ivoire reduced 6-MMD distribution (Q1:24.6%, Q4:14.9%).

CONCLUSIONS: MMD for ART increased substantially across all countries. Impacts on ROC satisfaction and outcomes such as retention and viral suppression should be assessed.