Introduction

Lagos has a HIV prevalence of 1.4% with an estimated 138,765 persons living with HIV (PLWH), and 116,937 are on treatment as at the end of 2021. The city confirmed its index case of Coronavirus (COVID-19) on 27th February 2020 and has continued to see an exponential increase in the number of confirmed cases since then. In order to curb the spread of COVID-19, the city’s HIV & AIDS program implementation was disrupted.

Description

Averting the challenges posed by COVID-19 is critical to the success of the city’s HIV and AIDS response. As part of its efforts to coordinate the State’s HIV response amidst the pandemic, the Lagos state AIDS Control Agency (LSACA) collaborated with members of the state HIV Consortium to develop a HIV/COVID-19 Contingency Plan.

Prior to the lockdown, as part of the contingency plan, Health facilities and 180 Community Pharmacies were stocked up with Antiretroviral (ARV) drugs for ease of refill for clients using the Hub and Spoke Model. The community pharmacies served as spokes while the health facilities served as Hubs. HIV clients with less than two (2) weeks drugs were actively tracked and recalled for drug refills at the pharmacies nearest to them. The multi-month drugs refill strategy (2-3 months drug refill) was adopted during the period to minimise clients visit to the hospital and ultimately reduce their exposure to COVID-19. This also prevented client’s drug stock out during lockdown to counteract poor drug adherence.

For the key populations with over 24,000 individuals currently on treatment as of March 2020, NGOs were engaged for ARV drug transport to client’s homes and neighbourhoods as applicable to each client. Viral load sample collection from eligible clients was done through the dry blood spot (DBS) method, while samples were transported to the PCR centres in the city for testing.

In the bid to sustain the HIV response in the city during the COVID-19 outbreak and as outlined in line with the contingency plan, emergency relief support was provided to essential health service providers working to roll out the contingency plan. These included, personal protective equipment for the HIV health care providers at facilities and community pharmacies; and psychosocial support to address the mental health issues associated with the COVID-19 pandemic for service providers.

Data Collection

Routine programmatic data from state owned facilities and implementing partners supporting the response in the city was used. The community pharmacies documented ARV refills using the national ARV client monitoring tools and registers. The data was reported to the Hub health facilities for updates to the clients’ records.

Results, Outputs, and Outcomes

The total number of eligible clients was 43,010 and 91% (39,010) were reached with ARV refills before and during the lockdown through the intervention.

The total number of eligible clients for viral load testing/sample collection was 16,140 and the number of samples collected was 11,640 within the lockdown. This resulted in a performance of 72% of viral load testing being attained (72% of the eligible clients’ samples were collected) for effective client monitoring.

Lessons Learned

Community ART programs and support structures played a significant role in sustaining clients ARV refill, Clinical monitoring, and drug adherence during the COVID-19 lockdown. Stable clients still get their medicines (post lockdown period) from community pharmacies. Courier services still deliver medicines to KP client’s doorsteps in line with the Differentiated Service Delivery model now fully implemented post lockdown.

The adoption of the DBS mode of sample collection was novel during the lockdown period. This helped to sustain the client level monitoring and adherence to ARVs.

Conclusion

The availability of ARV drugs in the community pharmacies and the strategy of home delivery of ARV prevented client’s drug stock out. The model adopted for easy access to drug refills is highly recommended and the strategy should be adopted and sustained.

At the ease of the lockdown, the viral load sample collection was reverted to the plasma collection as provided for in the country HIV and AIDS national guideline.