Introduction

Rwanda adopted strong measures to prevent the spread of COVID-19 including long term strict lockdown in all districts of Rwanda. The movement were strictly limited to everyone and people were requested to stay at home. People living with HIV on ART, new HIV infected who want to initiate ART or those who wanted to test for HIV were at high risk of not accessing services at usual. Though, the government offered a channel to request officially the pass permission to people with a clear reason of getting out. However, for people living with HIV or who want to access HIV related services with self-stigma were not ready to use official channel of requesting permission. Therefore, Network of people living with HIV, Ministry of Health/Rwanda Biomedical center/HIV program had to find out a home delivery approach of ART and Some HIV services to people ling with HIV and everyone who needed the services.
The biggest challenge was how to access ART during COVID-19 lockdown for PLHIV, Initiate ART for the new infected and accessing HIV testing services for those at high risk. The major affected were PLHIV and key populations. Interruption of ART among PLHIV leads to resistance on treatment, that can affect poorly the outcome of patients. The objective of the intervention was the following:
1. Ensure Continuation of accessing ART to PLHIV during lockdown
2. Ensure continuation of access to HIV testing to key populations

Description

The intervention focused on ART drugs and HIV self-testing home delivery to PLHIV and key populations during lockdown. A toll-free number (1245) was availed to everyone who have difficulties to access ART or HIV testing services. The home delivery services are still available even after lockdown. It was found that this approach reduced remarkably the lost to follow up and increased the HIV testing uptake. The service is being offered in Kigali and out of Kigali through coordination of Network of people living with HIV, Rwanda Biomedical center/HIV program and HIV partners in Rwanda. The drugs are being picked up to nearest health center and delivered by peer educators in that area.

Data Collection

The current indicators are being collected:
1. Number of PLHIV used toll free to access services
2. Number of PLHIV received ART at home
3. % of lost to follow up
4. Number of key populations used toll free to access services
5. Number of Key populations received self-testing kit at home

Results, Outputs, and Outcomes

So far there is no formal evaluation of the practice carried out. However, end March 2021 report showed 1790 PLHIV received their ART at home through this intervention.

Lessons Learned

Enablers:
1. The strong collaboration between Network of people living with HIV and Rwanda Biomedical Center /HIV Program enabled health centers to accept to give peer educators ART so that can be delivered at home.
2. The collaboration of Network of people living with HIV with partners (UNAIDS, GIZ, IAPAC) and Ministry of health enabled the set up and operations of toll free

Challenges:

1. Toll free requires permanent staff working 24/7 to ensure quality services but support availed was only 7/7. The recommendation was to go for 24/7 to not miss anyone behind
2. The toll free was only for home delivery, unfortunately more other complains among PLHIV were reported such domestic violence among discordant couples during lockdown etc…, the staff were overwhelmed with complains.

If relevant, Please describe the sustainability/continuity of the best practice within the context of the COVID-19 pandemic.

The Home delivery of ART drugs and self-testing kits was found to be of high importance to reduce lost to follow up and up taking HIV testing. This approach respond to UNAIDS global goals 1st 90 to know your HIV status, 2nd and 3rd 90 for retention and VL suppression. The approach is still valid even after lockdown since Rwanda adopted home based care approach for asymptomatic COVID-19 Confirmed cases. Therefore, PLHIV if he/she is confirmed COVID-19 positive then ART can still be delivered at home.

Conclusion

The intervention protected PLHIV for being exposed to COVID-19 during the movement of going in and out from their homes to Health centers. In addition of minimizing interruption to continuation of access to ART and early identification of HIV new infection.