Decentralized drug distribution during the COVID-19 surge in Ho Chi Minh City: lessons learned from antiretroviral drug home delivery via postal services

BACKGROUND: COVID-19 challenged Vietnam's centralized drug distribution management system, in place since antiretroviral (ARV) introduction in 2004. Stay-at-home orders and interprovincial travel restrictions required a pivot towards emergency drug dispensing via post. This process was first used in Ho Chi Minh City (HCMC) because of its COVID-19 burden, including a high number and proportion of patients from other provinces, and restrictions on interprovincial travel.
DESCRIPTION: Ten HIV treatment faciities (HTFs) in HCMC initiated postal ARV distribution in late May 2021. Facility staff developed lists of clients that relocated to other provinces. Patients were then contacted to obtain consent for mail delivery and confirm addresses and agreement to pay for postage upon delivery. HTFs contracted with the two most popular postal service companies. Patients in quarantine for or infected with COVID-19 were also eligible for postal ARV delivery.
LESSONS LEARNED: From May to September 2021 (peaking in July and August), 6,825 30-count ARV bottles were mailed to 4,188 patients, representing 22.7% of the patients served by the 10 HTFs. A total of 4,138 of these patients resided outside HCMC. Given interprovincial travel restrictions, postal service was optimal for delivering drugs to these clients. Postage did not exceed US$2 per parcel, and patients were generally willing and able to pay these delivery costs. This approach made ARVs accessible to clients and promoted continuity of treatment who lived outside of HCMC or had temporarily relocated during a COVID-19 surge in the city. Home delivery also reduced COVID-19 transmission risks and removed barriers to treatment continuation. Nevertheless, postal distribution slowed or was temporarily disrupted when the COVID-19 outbreak peaked. Two hundred ARV bottles were stuck in distribution centers because of post office closures due to infected staff or lockdowns at recipient locations. Six bottles were returned to senders and 13 were lost in transit. These service delays and disruptions posed challenges for patient adherence and HTF drug management.
CONCLUSIONS: Postal delivery was effective for ARV distribution, removing a barrier to treatment continuation. As current national guidelines do not allow for this approach, advocacy efforts are needed for adoption of decentralized drug distribution beyond the COVID-19 context.

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