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Impact of crisis-driven interventions on averting Lost to follow-up among people living with HIV on antiretroviral therapy in Mumbai, India

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BACKGROUND: India had national and provincial lockdowns that prompted outmigration before they took effect during two COVID-19 waves. The pandemic posed challenges to treatment continuity and reengagement among people living with HIV (PLHIV). Multiple interventions were adapted to prevent lost to follow-up (LTFU: no pill pick-up for >28 days since last expected pick-up) in Mumbai metro-city, which caters to 38,000 PLHIV, many of whom are migrants.
DESCRIPTION: We proactively generated a list of PLHIV due for their pill pick-up and called them. An automated interactive voice response system (ART-MITRA) prompted callers to respond on their availability, and a convenient location to reach a nearby ART center. To enable treatment continuity in the setting of out-migration, we instituted an E-transfer-out system. Decentralized drug distribution (DDD) was set up. To avert calling delays, we enhanced data to use to reach PLHIV prior to and on the day of missing pill pick-up. During April- July 2021, we rapidly re-activated and adapted the entire response package of tracking and tracing, and added teleconsultations for the severely ill, along with courier services and community refills.
LESSONS LEARNED:

In March 2020, of the 7,480 PLHIV due for refill 47% PLHIV were reachable. Through ART-MITRA 1300 PLHIV collected their pills. An additional 1660 PLHIV collected pills from 13 DDD sites. With enhanced case-based tracking, and calling of 27,980, 18,002 (64%) were reached, and 4,866 LTFU PLHIV were re-engaged from October ' to March of 2021. During the second wave, teleconsultations for severely ill PLHIV and ART delivery through community volunteers and couriers resulted in the prevention of 1,559 LTFU. A significant (P<0.001) 50% decline in LTFU was observed between the two COVID-19 peaks.
CONCLUSIONS: Interventions tailored to the situation on the ground, and rapid reactivation in subsequent surges led to a decline in LTFU rate and allowed for maintenance of treatment gains.