Abstractobjectives Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned.methods A literature review of published articles on integrated NCD and HIV programs in lowincome countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration.results Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models.conclusions Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients.

Introduction The COVID‐19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID‐19 preparedness and response plans were rapidly instituted across sub‐Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID‐19 pandemic would have in under‐resourced settings with high burdens of PLHIV. The potential negative impact of COVID‐19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID‐19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID‐19‐related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID‐19. This commentary reviews PEPFAR’s COVID‐19 technical guidance and provides country‐specific examples of programme adaptions in sub‐Saharan Africa. Discussion The COVID‐19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over‐burdened health systems. Although there is currently limited understanding of how COVID‐19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID‐19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in‐person home and facility visits and other direct contact when COVID‐19 control measures are in effect. PEPFAR‐supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID‐19 in sub‐Saharan Africa. Conclusions As community transmission of COVID‐19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data‐driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID‐19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.

Background: Lesotho adopted the test-and-treat approach for HIV treatment in June 2016, which increased antiretroviral treatment (ART) clinic volume. We evaluated community-based vs. facility-based differentiated models of multimonth dispensing of ART among stable HIV-infected adults in Lesotho. Methods: Thirty facilities were randomized to 3 arms, facility 3-monthly ART (3MF) (control), community ART groups (3MC), and 6-monthly community distribution points (6MCD). We estimated risk differences (RDs) between arms using population-averaged generalized estimating equations, controlling for baseline imbalances and specifying for clustering. The primary outcome was retention in ART care by intention-to-treat and virologic suppression as a secondary outcome (ClinicalTrials.gov: NCT03438370). Results: A total of 5,336 participants were enrolled, with 1898, 1558, and 1880 in 3MF, 3MC, and 6MCD, respectively. Retention in ART care was not different across arms and achieved the prespecified noninferiority limit (−3.25%) between 3MC vs. 3MF (control); 6MCD vs. 3MF; and 6MCD vs. 3MC, adjusted RD = −0.1% [95% confidence interval (CI): −1.6% to 1.5%], adjusted RD = −1.3% (95% CI: −3.0% to 0.5%), and adjusted RD = −1.2% (95% CI: −2.9% to 0.5%), respectively. After 12 months, 98.6% (n = 1503), 98.1% (n = 1126), and 98.3% (n = 1285) were virally load (VL) suppressed in 3MF, 3MC, and 6MCD, respectively. There were no differences in VL between 3MC vs. control and 6MCD vs. control, risk ratio (RR) = 1.00 (95% CI: 0.98 to 1.01) and RR = 1.00 (95% CI: 0.98 to 1.01), respectively. Conclusions: There were no differences in retention and VL suppression for stable HIV-infected participants receiving multimonth dispensing of ART within community-based differentiated models when compared with the facility-based standard-of-care model.