Focus on Multi-month dispensing of Antiretroviral Therapy among HIV-infected patients in Kenya during the COVID-19 lockdown period.

Abstract

Under WHO guidance, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) strongly encouraged countries to take prompt action to mitigate the potential negative consequences of COVID-19 on existing programs supported by PEPFAR grants. Particular attention was given to health worker protection, communication with affected communities, maintenance of essential services, supply chain coordination, early replenishment of stocks, disinfection of assets, and waste management. Differentiated care is a client-centered approach that simplifies and adapts HIV services across the cascade, in ways that both serve the needs of people living with HIV (PLHIV) better and reduce unnecessary burdens on the health system (PEPFAR, 2020). The health system implications of this client-centered approach are clear: when a health system adopts a more responsive model of care, tailored to the needs of various groups of PLHIV, it can allocate resources more effectively, provide better access for underserved populations and deliver care in ways to improve quality of care and life (Grimsrud et al., 2016).

Multi-month dispensing (MMD) is a facility-based, individual-focused DSD model, in which recipients of care who are doing well on ART receive larger amounts of ART at each visit, enabling their appointments to be spaced at longer intervals (Nascop, 2017). MMD was combined with appointment spacing and fast-track approaches to minimize the amount of time that PLWHIV needed to spend at health facilities. Continuity of treatment for PLHIV is the foundation of PEPFAR programs during the COVID-19 pandemic. Multi-month dispensing (MMD) and decentralized delivery of medication formed the basis of the PEPFAR strategy to maintain PLHIV on ART. Minimizing patient contact with health facilities reduces risk to recipients of care and reduces the burden on these facilities. Health care facility visits were limited to those that are medically essential (PEPFAR, 2020).

The critical intervention for all programs and individuals was to accelerate and scale-up 3-6 multi-month dispensing of antiretroviral therapy (ART) and decentralized distribution for all PLHIV including pregnant and breastfeeding women and children (CQUIN Learning Network, 2019). PEPFAR recommended that ALL PLHIV who were starting ART receive at least 3 but preferably 6 months of drugs. Phone or electronic follow-up may be helpful to assess and support adherence and to assess and manage side effects. Clients who were receiving medication from elsewhere regardless of their citizenship or immigration status, were provided medication. Every effort was made to trace individuals who had been lost to follow-up and provide them with the package of care and treatment that they required before COVID-19 disruptions worsened (Katureebe C, Ngugi C, 2020).