Journal of AIDS & Clinical Research

Robust Progress in ARV Optimization for Adolescents and Adults in PEPFAR Partner Countries during the First Years of COVID−19

Abstract

Rachel A. Golin*, Miriam M. Hartig, B. Ryan Phelps, Dessalegn Tesfaye, Jeffrey M. Samuel, Christine Y. Malati, Katelyn A. Morgan and George K. Siberry

Problem: The United States President’s Emergency Plan for AIDS Relief (PEPFAR) partner countries have been directly impacted by multiple waves of COVID-19 since early 2020. The HIV global supply chain in particular experienced drastic manufacturing and logistic disruptions. This public health crisis has tested the resilience of national HIV programs as ministries of health (MoH) and donors worked to maintain HIV programs while implementing COVID-19 readiness and response actions. Our goal was to assess progress in dolutegravir (DTG) transition for adolescent and adult populations during COVID-19.

Local Setting: Sixteen countries that receive support from PEPFAR, through the United States Agency for International Development (USAID), met the following inclusion criteria during both six month reporting periods (October 2019 - March 2020 and April 2022 - September 2022):

• PEPFAR/USAID supported HIV treatment to people living with HIV (PLHIV) ≥ 15 years,

• PEPFAR/USAID supported a supply chain program, and

• Complete and consistent reporting was available for both programmatic metrics: number of PLHIV on treatment and ARVs dispensed.

Methods: Starting in early 2020, PEPFAR published routine guidance for its programs to mitigate commodity disruption and promote HIV treatment continuity while minimizing potential COVID-19 transmission. Person-centered service delivery was promoted through expansion of differentiated service delivery, including the use of telephonic and internet-based support platforms. Clinical and supply plan tools were developed and adapted to meet evolving program needs. Monitoring frameworks tracked program adaptations and solutions, and virtual meetings were convened to disseminate best practices.

Findings: Collaboration across stakeholders remained crucial. In all 16 countries, the proportion of first-line DTG-based regimens dispensed increased between March 2020 and September 2022. While the total number of bottles of first-line ARVs dispensed increased in 13 (81%) countries, the total number of bottles of DTG-based regimens dispensed increased in all 16 countries. The reported number of PLHIV ≥ 15 years of age receiving ART from USAID-supported facilities increased in 15 (94%) countries

Conclusion: Proactive, coordinated service delivery and strategic supply chain adjustments protected high quality HIV treatment and increased uptake of DTG, resulting in millions of PLHIV receiving the benefits of DTG-based treatment during the first years of the COVID-19 pandemic. The introduction and scaling of DTG-based regimens as planned despite COVID-19 demonstrated the ability of PEPFAR and MoH to engage in proactive supply planning and monitoring, while ensuring job aids and training were available to educate providers. The successes and lessons learned will allow the global health community to respond more effectively to inevitable, future disruptions.

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