Protecting HIV Prevention, Care, and Treatment Services During COVID-19 Response

With PEPFAR/USAID’s support, JSI, ministries of health, and community partners provide life-saving antiretrovirals (ARVs) for more than 500,000 people living with HIV (PLHIV) across Africa. We test more than 2 million people a year for HIV, helping detect new infections quickly, and encouraging safer sexual behaviors. Our staff provide over 15,000 people with pre-exposure prophylaxis (PrEP), a daily pill to prevent new HIV infections and keep the burden of disease low. 

COVID-19 threatens these programs and may result in a significant loss of life, both through direct mortality and by overwhelming health systems across the continent. 

USAID, ministries of health (MOH), community partners, and JSI are rushing to adapt interventions to serve HIV-affected communities. But even as we brace for this challenge, we take stock of our resources: PEPFAR’s investments in health worker training, clinic infrastructure, and health communications give us the opportunity to mount a response to COVID-19 while protecting our progress in HIV epidemic control.  

Adapting our HIV programs for lockdowns and protecting our staff

Movement restrictions related to physical distancing, quarantine, and lockdown help reduce COVID-19 transmission but may have negative effects on HIV care. Some clients may not want to visit health facilities for drug refills, and many may not be able to participate in community support and adherence groups. 

Where supplies and local policy permit, JSI mitigates the risk of treatment interruption, providing PLHIV with a 6-month supply of ARVs and PrEP clients with a 3-month supply. Condom distribution is vitally important, especially as lockdowns may lead to increased risk of sexual exposure as well as intimate partner violence, both of which are important risk factors for HIV transmission. Finally, we are using social media to maintain client contact and generate demand for HIV-prevention services like HIV self-testing, voluntary male medical circumcision, and PrEP. In this way, we will be ready to reopen our on-site HIV programming when it is safe to do so. 

Learning from other outbreaks

As we design and implement COVID-19 interventions, post-Ebola outbreak service delivery interventions offer important lessons. 

Through the USAID Advancing Partners & Communities project, JSI collaborated with MOH and nongovernment and faith-based organizations to reduce stigma and other barriers to health care services for Ebola survivors. This included revitalizing health facilities, and sensitivity training for health professionals and community health workers, and hiring and training peer supervisors. 

These approaches helped build resilient and self-sustaining health systems to prevent future outbreaks and respond to the particular needs of recovering Ebola patients. Given the preliminary data that COVID-19 patients may have long-term health sequelae requiring more extensive health care, JSI is supporting MOH to develop immediate and long-term health system plans.

Leveraging PEPFAR-investments for COVID-19 mitigation

Across Africa, JSI is working with MOH and community partners to train staff and partners on COVID-19 transmission, symptoms, prevention methods, and implications for PLHIV. We are leveraging social networks and existing communication channels (phone calls, SMS, and WhatsApp, and other social media apps) to maintain contact with beneficiaries and reduce the need for physical outreach. JSI is developing social and behavior change communication materials to support the adoption of COVID-19-prevention behaviors. Where possible, we are providing infection prevention and control supplies and equipment for staff. 

For example, in Zambia, through the USAID DISCOVER-Health project, JSI is assisting with procurement of equipment, commodities, and supplies for the national COVID-19 response. We have supported the MOH to develop a COVID-19 Risk Communication & Community Engagement Plan, outlining multi-sector roles and responsibilities during prevention, preparedness, response, and recovery phases.

Also in Zambia, the USAID Electronic Supply Chain Management Information System Project, led by John Snow Health Zambia with support from JSI, has been collaborating with MOH, CDC, and other partners to develop an application for surveillance and contact tracing on CommCare, Dimagi’s digital case management platform.

In addition to these country-specific interventions, JSI is developing interventions to support mental health challenges arising from COVID-19 fears and social isolation and to respond to increases in domestic violence while under lockdown. JSI will support families experiencing violence through virtual psychosocial support, de-escalation strategies, and referral to local resources. We will sensitize community and health care workers to the increased risk of domestic violence that people may face during the pandemic.

Written by Sean Maher and Antonia Powell