Six-month Antiretroviral dispensing and other comprehensive, person-centered HIV care to increase service efficiency, client convenience and risk of COVID-19 infection in three provinces in Zambia''''

BACKGROUND: The USAID SAFE program (SAFE) supports the Ministry of Health (MOH) in Zambia with an integrated approach to HIV prevention and treatment. A five-year (2017'2022) project, SAFE operates in three provinces and has supported 302 health facilities through the COVID-19 pandemic with an increasing volume of people living with HIV (PLHIV) receiving treatment.
DESCRIPTION: SAFE collaborated with the MOH to decrease clinic congestions, increase service efficiency and client convenience, while reducing clients' clinic visit burden and risk of COVID-19 transmission. SAFE implemented the following strategies: (1) transition of stable clients to 6 multi-months dispensation (MMD) supply of ART drugs when eligible (2) community integrated delivery of services such as ART deliveries/dispensation, TPT initiation/refill, cervical cancer screening, viral load (VL) sample collection and monitoring, and family planning; (3) regular review of ART stock status to ensure adequate availability; (4) after-hours and weekend clinics for those unable to access ART during normal working hours; and (5) clinical camps and intensive calling of clients for drug pick-up and/or top-up prior to predicted COVID-19 waves by Zambia National Public Health Institute.
LESSONS LEARNED: In March 2020, out of 307,778 clients on ART, 66% (203,134) physically attended clinics, with 29% (83,706) of all clients on 6MMD, 47% (136,211) on 3-5 MMD, and 24% (68,198) on less than three months. By December 2021, the overall population of clients on ART increased by 2% (315,245), but the number physically attending clinics in the month decreased by 30% (143,218), with 68% (215,293) of all clients on 6MMD, 24% (75,912) on 3-5 MMD, and the remaining 8% (24,094) on less than three months.
CONCLUSIONS: The 6MMD and other decongestion measures greatly reduced the volume of health facility visits by PLHIV, while serving larger numbers overall. The reduction in the number of PLHIV attending the facility on each clinic day enabled adherence to COVID prevention measures as there was adequate space for social distancing that enabled sufficient time for health practitioners to attend each client. SAFE will continue to support the MOH to maintain person-centered approaches like 6MMD and community services.

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