Acceleration of differentiated service delivery for HIV treatment in sub-Saharan Africa during COVID-19.

Introduction: In response to COVID-19, national ministries of health adapted HIV service delivery guidelines to ensure uninterrupted access to antiretroviral therapy (ART) and limit the frequency of contact with health facilities. In this commentary, we summarize four ways in which differentiated service delivery (DSD) for HIV treatment has been accelerated during COVID-19 in policy and implementation in sub-Saharan Africa (SSA) - (i) expanding eligibility for DSD for HIV treatment, (ii) extending multi-month dispensing (MMD) and reducing the frequency of clinical consultations, (iii) emphasizing community-based models and (iv) integrating/aligning with TB preventative therapy (TPT), non-communicable disease (NCD) treatments and family planning commodities.

Discussion: Across SSA in 2020, countries both adapted and emphasized policies supporting DSD for HIV treatment in response to COVID-19. Access to DSD for HIV treatment was expanded by reducing the time required on ART before eligibility and being more inclusive of specific populations including children and adolescents, pregnant and breastfeeding women and those on second- and third-line regimens. Access to extended ART refills, or MMD, was accelerated across many countries. A renewed focus was given to out-of-facility community-based models of ART distribution. In some settings, there was acknowledgement of the need to integrate or align other chronic medications with ART.

Conclusions: Adaptations to DSD for HIV treatment in response to COVID-19 have resulted in rapid policy change and in some cases, acceleration of implementation in SSA. As the COVID-19 pandemic evolves, there is a critical need to assess the impact of these adaptations and, where beneficial, ensure that policies implemented in response to COVID-19 become the new normal.