Lessons Learned from Programmatic Gains in HIV Service Delivery During the COVID-19 Pandemic - 41 PEPFAR-Supported Countries, 2020

Abstract

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports country programs in identifying persons living with HIV infection (PLHIV), providing life-saving treatment, and reducing the spread of HIV in countries around the world (1,2). CDC used Monitoring, Evaluation, and Reporting (MER) data* to assess the extent to which COVID-19 mitigation strategies affected HIV service delivery across the HIV care continuum^† globally during the first year of the COVID-19 pandemic. Indicators included the number of reported HIV-positive test results, the number of PLHIV who were receiving antiretroviral therapy (ART), and the rates of HIV viral load suppression. Percent change in performance was assessed between countries during the first 3 months of 2020, before COVID-19 mitigation efforts began (January-March 2020), and the last 3 months of the calendar year (October-December 2020). Data were reviewed for all 41 countries to assess total and country-level percent change for each indicator. Then, qualitative data were reviewed among countries in the upper quartile to assess specific strategies that contributed to programmatic gains. Overall, positive percent change was observed in PEPFAR-supported countries in HIV treatment (5%) and viral load suppression (2%) during 2020. Countries reporting the highest gains across the HIV care continuum during 2020 attributed successes to reducing or streamlining facility attendance through strategies such as enhancing index testing (offering of testing to the biologic children and partners of PLHIV)^§ and community- and home-based testing; treatment delivery approaches; and improvements in data use through monitoring activities, systems, and data quality checks. Countries that reported program improvements during the first year of the COVID-19 pandemic offer important information about how lifesaving HIV treatment might be provided during a global public health crisis.

FIGURE

Percent change in HIV-positive test results (A), number of persons with HIV receiving antiretroviral therapy (B), and rates of viral load suppression (C) — U.S. President’s Emergency Plan for AIDS Relief, 41 countries, January–March to October–December 2020 Abbreviations: ART = antiretroviral therapy; UNAIDS = Joint United Nations Programme on HIV/AIDS; WHO = World Health Organization. * Number of persons who received a positive HIV test result. https://datim.zendesk.com/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides ^† Number of adults and children who are currently receiving ART in accordance with the nationally approved treatment protocol (or WHO/UNAIDS standards) at the end of the reporting period. https://datim.zendesk.com/hc/en-us/articles/360000084446-MER-Indicator-Reference-Guides ^§ Percentage of viral load suppression. Only sites that are in the highest quartile in both prepandemic (January–March 2020) and pandemic (October–December 2020) periods are included. Thirty-four of the 41 countries were included; seven countries did not report data for the viral load indicator.