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. 2021 Dec 21;9(4):978-989.
doi: 10.9745/GHSP-D-21-00168. Print 2021 Dec 31.

How Home Delivery of Antiretroviral Drugs Ensured Uninterrupted HIV Treatment During COVID-19: Experiences From Indonesia, Laos, Nepal, and Nigeria

Theresa Hoke  1 , Moses Bateganya  2 , Otoyo Toyo  3 , Caroline Francis  4 , Bhagawan Shrestha  5 , Phayvieng Philakone  6 , Satish Raj Pandey  7 , Navindra Persaud  8 , Michael M Cassell  9 , Rose Wilcher  2 , Hally Mahler  8
Affiliations

How Home Delivery of Antiretroviral Drugs Ensured Uninterrupted HIV Treatment During COVID-19: Experiences From Indonesia, Laos, Nepal, and Nigeria

Theresa Hoke et al. Glob Health Sci Pract. .

Abstract

Introduction: Faced with the coronavirus disease (COVID-19) pandemic, governments worldwide instituted lockdowns to curtail virus spread. Health facility closures and travel restrictions disrupted access to antiretroviral (ARV) therapy for people living with HIV. This report describes how HIV programs in Indonesia, Laos, Nepal, and Nigeria supported treatment continuation by introducing home delivery of ARVs.

Methods: Staff supporting the programs provided accounts of when and how decisions were taken to support ARV home delivery. They captured programmatic information about home delivery implementation using an intervention documentation tool. The 4 country experiences revealed lessons learned about factors favoring successful expansion of ARV home delivery.

Results: Three of the countries relied on existing networks of community health workers for ARV delivery; the fourth country, Indonesia, relied on a private sector courier service. Across the 4 countries, between 19% and 51% of eligible clients were served by home delivery. The experiences showed that ARV home delivery is feasible and acceptable to health service providers, clients, and other stakeholders. Essential to success was rapid mobilization of stakeholders who led the design of the home delivery mechanisms and provided leadership support of the service innovations. Timely service adaptation was made possible by pre-existing differentiated models of care supportive of community-based ARV provision by outreach workers. Home delivery models prioritized protection of client confidentiality and prevention measures for COVID-19. Sustainability of the innovation depends on reinforcement of the commodity management infrastructure and investment in financing mechanisms.

Conclusion: Home delivery of ARVs is a feasible client-centered approach to be included among the options for decentralized drug distribution. It serves as a measure for expanding access to care both when access to health services is disrupted and under routine circumstances.

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Figures

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Discreet packaging of antiretroviral drugs in Jakarta, Indonesia. © 2020 Ade Sonyville and Arifin Fitrianto/LINKAGES/FHI 360 Indonesia
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Outreach worker on the way to delivering antiretroviral drugs to clients at their homes in Nepal. © 2020 NAMUNA/LINKAGES/FHI 360
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A community pharmacist boards at the jetty with supplies for clients along remote creeks in Akwa Ibom State, Nigeria. © 2020 Otoyo Toyo/AHNI
See this image and copyright information in PMC

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