A plan maintains continuity of HIV care in a Nigerian state during COVID-19 lockdown

The COVID-19 pandemic poses a double threat for people living with HIV, who must find ways during lockdown to access their antiretroviral therapy from overwhelmed health facilities. In addition, people who have the virus but are not yet diagnosed face challenges getting tested and initiating treatment.

Akwa Ibom State in southern Nigeria, near the border with Cameroon, is a center of oil and gas production — populous and with a high prevalence of HIV. It recorded its index case of COVID-19 on April 1, 2020, and the following day the federal government enforced a nationwide lockdown. Suddenly, HIV clients experienced curtailed access to drugs and support services, threatening their long-term health and ability to be linked to or adhere to HIV treatment.

Faced with likely interruptions in HIV testing, treatment monitoring, and retention in care, staff working in Akwa Ibom on the Data for Implementation (Data.FI) project, funded by USAID, scrambled to minimize the disruption. Accustomed to in-person Epidemic Control Room meetings to regularly review HIV data to ensure that patient care is optimized — a practice we call “Situation Room” meetings — the Data.FI team and local health decision makers pivoted to virtual meetings with the same goal. Working with the Akwa Ibom State Ministry of Health , we continued the weekly meetings virtually, quickly adjusting the HIV data reviews for the COVID-19 context.

Optimizing HIV testing strategies: The lockdown restricted movement, curtailing visits to health facilities and community drives for HIV testing. The state health ministrytherefore adjusted its HIV testing strategy to prioritize key populations (men who have sex with men, sex workers, injecting drug users, and transgender people) and redoubled efforts to track people whose tests returned an HIV-positive result in the community. Another decision was to re-emphasize provider-initiated HIV testing and counselling for clients presenting at a facility.

• Result: While the lockdown depressed the volume of testing, this more targeted approach increased the percentage of confirmed HIV-positive individuals among all tested.

Prioritizing safety at health facilities: The health ministry continued its efforts to ensure that staff were equipped with proper personal protective equipment  and were trained on safety measures to safeguard clients.

• Result: These continued precautions allowed facilities to provide ongoing services and referrals for HIV-positive clients.

Reducing barriers to ART initiation: Community teams and support groups for PLHIV were equipped with PPE and passes to allow movement (the latter being a government policy requirement). Meanwhile, the state decided to enforce same-day ART initiation for everyone newly diagnosed with HIV.

• Result: Community teams visited clients and were able to immediately initiate newly diagnosed clients on ART.

Extending options for ART distribution: During the lockdown, clients still needed drugs and community-based support to help them remain in treatment. Partner organizations working with us to deliver HIV services intensified community-based drug refills through community ART groups, community pharmacies, and multi-month dispensing ― provision of more than one month’s drug supply. The Situation Room team decided that client follow-up remained essential, especially because MMD meant that clients wouldn’t visit clinics every month.

• Result: Multi-month dispensing previously included clients who were stable on treatment and had achieved viral suppression. During the lockdown, revised criteria allowed even newly initiated clients to acquire a three-months supply. Averting loss to follow-up among clients meant that pre-emptive tracking was encouraged, especially for new clients. Healthcare providers prioritized clients who needed intensified support (e.g., those with a history of poor adherence, and pregnant and breastfeeding women living with HIV). Providers also encouraged community organizations and networks of people living with HIV to keep in frequent contact with them to communicate about any medical issues or changes in clients’ health status.

Stakeholders Sustain Action

In collaboration with the SMOH and partner organizations, we are continuing to ensure weekly virtual Situation Room meetings to support continued services and help the Ministry of Health to monitor HIV testing, treatment statistics and care referrals. As Nigeria enters its next phase of the COVID-19 response, Data.FI will continue to support decision making based on data.