Silver linings: how COVID‐19 expedited differentiated service delivery for HIV

Implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation

“…Some previously identified tracking issues were amplified, such as challenges with documenting when patients obtained refills, because more patients were using CCMDD [ 33 ]. However, some changes to CCMDD during the pandemic may have strengthened the program [ 34 ], which not only continued uninterrupted throughout the pandemic, but also increased the number of people eligible, reduced refill frequency, extended the period in between clinic visits from 6 months to 1 year, and increased the number of community pick-up points (including in smart lockers that did not require staff to be present) [ 35 ]. Similar policy changes throughout sub-Saharan Africa during the pandemic resulted in scale-up of differentiated service delivery models [ 35 , 36 ].…”

Innovations, adaptations, and accelerations in the delivery of HIV services during COVID-19

“…Complementing published experiences, 6 , 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 data were shared on service disruptions and mitigations in relation to HIV testing, antiretroviral therapy (ART), viral load testing, viral load suppression, pre-exposure prophylaxis (PrEP), prevention of vertical transmission, and voluntary medical male circumcision. Under-recognised factors that restricted HIV service delivery included staff shortages from illness, staff redeployment towards COVID-19, disruptions of public transportation services to travel to health facilities, and use of health facilities as isolation centers.…”

“…The acceleration of approaches, such as HIV self-testing, multimonth dispensing of ART and PrEP and other differentiated service delivery models, flexible harm reduction, and mental health services, were examples of successful adaptations. 6 , 15 , 16 , 19 Community-based and community-led interventions, use of telemedicine (ie, the provision of remote clinical services), the generation of demand for health services, and integration of COVID-19 information, vaccination, and provision of PPE were other key innovations and adaptations. Community networks reported that, in many settings, community-led responses were the first to ensure that the needs of their community were met, including the transportation of antiretrovirals from clinics or hospitals to homes, and the distribution of needles, syringes, condoms, and PPE.…”

“…4 , 5 Stakeholders took diverse actions to mitigate negative consequences of the pandemic and document lessons learned, and HIV treatment continuity appears to have remained stable during 2020. 6 , 7 , 8 , 9…”

Can COVID-19 changes reduce stigma in African HIV clinics?

“…As health-care systems have adapted to reduce the risk of SARS-CoV-2 transmission, they have shown that there is bandwidth for new care delivery models that might be more client-centred. 9 Additionally, improving clinic privacy would have many downstream improvements for the HIV care cascade. The global pandemic might have shifted institutional inertia, which could provide an opportunity to enact these changes.…”