Changes in HIV treatment differentiated care uptake during the COVID‐19 pandemic in Zambia: interrupted time series analysis

Abstract

IntroductionDifferentiated service delivery (DSD) models aim to improve the access of human immunodeficiency virus treatment on clients and reduce requirements for facility visits by extending dispensing intervals. With the advent of the COVID‐19 pandemic, minimising client contact with healthcare facilities and other clients, while maintaining treatment continuity and avoiding loss to care, has become more urgent, resulting in efforts to increase DSD uptake. We assessed the extent to which DSD coverage and antiretroviral treatment (ART) dispensing intervals have changed during the COVID‐19 pandemic in Zambia.MethodsWe used client data from Zambia's electronic medical record system (SmartCare) for 737 health facilities, representing about three‐fourths of all ART clients nationally. We compared the numbers and proportional distributions of clients enrolled in DSD models in the 6 months before and 6 months after the first case of COVID‐19 was diagnosed in Zambia in March 2020. Segmented linear regression was used to determine whether the outbreak of COVID‐19 in Zambia further accelerated the increase in DSD scale‐up.Results and discussionBetween September 2019 and August 2020, 181,317 clients aged 15 or older (81,520 and 99,797 from 1 September 2019 to 1 March 2020 and from 1 March to 31 August 2020, respectively) enrolled in DSD models in Zambia. Overall participation in all DSD models increased over the study period, but uptake varied by model. The rate of acceleration increased in the second period for home ART delivery (152%), 2‐month fast‐track (143%) and 3‐month MMD (139%). There was a significant reduction in the enrolment rates for 4‐ to 6‐month fast‐track (−28%) and “other“ models (−19%).ConclusionsParticipation in DSD models for stable ART clients in Zambia increased after the advent of COVID‐19, but dispensing intervals diminished. Eliminating obstacles to longer dispensing intervals, including those related to supply chain management, should be prioritized to achieve the expected benefits of DSD models and minimize COVID‐19 risk.

Interrupted time-series analysis of active case-finding for tuberculosis during the COVID-19 pandemic, Zambia

“…A national campaign had been initiated to make early contact with all people living with HIV and to provide extended ART refills (up to 6 months) in March and early April 2020. 12 Notably, in the first 3 months of the pandemic in Zambia, and following a large immediate decline in tuberculosis notifications, we found that case numbers either stayed flat or continued to decline among most subgroups and in most provinces. These data have important implications, as even short disruptions in tuberculosis services and transient declines in tuberculosis notifications may result in thousands of additional tuberculosis-related deaths and many new incident tuberculosis cases due to prolonged periods of infectiousness.…”

Do not forget the children: a model‐based analysis on the potential impact of COVID‐19‐associated interruptions in paediatric HIV prevention and care

“…Differentiated service delivery (DSD) may help to minimize the risk of COVID-19 exposure while continuing to meet the healthcare needs of pregnant women and CLWH [30,31]. There was an increased demand for DSD during the pandemic [32], with evidence supporting its non-inferiority compared to the standard of care [33,34]. Dispensing multi-month ART prescriptions, a cornerstone of the DSD framework, can enable individuals to maintain ART adherence without frequent clinic visits, as demonstrated in Tanzania and Namibia [35,36].…”

Availability and experiences of differentiated antiretroviral therapy delivery at HIV care facilities in rural Zimbabwe: a mixed‐method study

“…We collected data from 378 PLHIV at 25 facilities; one of the rural health centres did not have HIV consultations on the day of data collection. A median of 16 PLHIV participated at each facility (IQR: [12][13][14][15][16][17][18][19]. The median age of participants was 41 years (IQR: 32-51 years); 245 (65%) were female.…”

“…However, implementation barriers, including insufficient staff training, lack of dedicated personnel or insufficient support and resources, may prevent the successful implementation and uptake of differentiated ART delivery [14][15][16]. Health emergencies, such as the recent coronavirus (COVID-19) pandemic, can also challenge the HIV care delivery, especially where services are already stretched [17,18]. In this context, DSD can reduce the burden on providers by offering community-and facility-based models of ART delivery with fewer clinic visits [19].…”