Successful continuation of antiretroviral therapy delivery during COVID 19 – best practices from the South East Asia Region

The COVID-19 pandemic was predicted to and has had a major impact on the essential HIV health services in the South East Asia Region (SEAR), putting at risk the benefits accrued over the last two decades. Apart from the risks posed by the virus to the individual health of people living with HIV (PLHIV), COVID-19 has disrupted essential services causing considerable delays in the delivery of medicines and other health commodities. Changing priorities for HIV clinic and health-care workers, travel restrictions, non-availability of public and limited private transportation and worsening socio-economic contexts affected continuity of essential HIV services.

To help mitigate these effects, at the onset of the pandemic, WHO issued guidance on WHO issued guidance on maintaining essential health services maintaining essential health services including specific measures such as multi-month dispensing (MMD) of antiretroviral (ARV) drugs to those who are clinically stable on current treatment and take-home doses of opiate substitution therapy (OST) drugs for people who inject drugs.

Based on this guidance, countries in the SEAR were quick to work with communities to put in place measures to allow for continuation of essential HIV services.  Results include:

National programmes in 8 out of 10 countries in the region have issued guidelines for MMD of ARV drugs and take-away doses of OST drugs, beefing up their ARV stocks and supply chains

• Antiretroviral therapy (ART) distribution has been successfully decentralized from ART centers to primary health care and community facilities
• Training is being provided to the ART teams on Covid-19 related issues. Hand sanitizers are also provided for clinical staff
• WhatsApp and google hangout meetings are being conducted with programme managers and community leaders to support State teams in addressing coordination issues and to facilitate cross learning. Real time information about clients, treatment requirement, good practices and handling of emergency situations are also shared through these groups.
• Home delivery of ARV medicines (for patients unable to reach facilities) is being done by community outreach workers, many a time using their own motor bikes, by foot or through donated ambulances.
•  The police have been mobilized and sensitized to allow peer workers to deliver ARV drugs. 
• ‘Providing Nutritional Support for People Living with HIV/AIDS (PLHIV) in Nanded District’:  Pride India, a local NGO, which operates the CSC in Nanded district of Maharashtra is working with Network of Maharashtra by People Living with HIV/AIDS (NMP+) to provide nutrition support to 385 members who were in need of nutrition support for three months after the announcement of lockdown. 

Credit: courtesy Alliance India