TY - JOUR
T1 - HIV service delivery in the time of COVID-19
T2 - focus group discussions with key populations in India
AU - Pollard, Rose
AU - Gopinath, Usha
AU - Reddy, Yeruva A.
AU - Kumar, Bogam R.
AU - Mugundu, Parthasarathy
AU - Vasudevan, Canjeevaram K.
AU - Srikrishnan, Aylur K.
AU - Singh, Aditya
AU - McFall, Allison M.
AU - Mayer, Kenneth H.
AU - Mehta, Shruti H.
AU - Solomon, Sunil S.
N1 - Funding Information:
SSS received consulting fees and research grants and products for his institution from Gilead Sciences and research grant and product from Abbott Laboratories outside of the submitted work. SSS and SHM received consulting fees from Gilead Sciences outside of the submitted work. KHM has received research grants outside of the submitted work for his institution from Gilead, Merck and Janssen, and has served on scientific advisory boards for Gilead, Merck and ViiV focused on HIV prevention.
Funding Information:
This project has been supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through a cooperative agreement through the United States Agency for International Development (USAID) under the terms of cooperative agreement #72038619CA00001. We sincerely thank all discussion participants for their time and involvement. We also thank the program staff who conducted interviews and local CBOs who supported recruitment. We also acknowledge PEPFAR, USAID, NACO and the Maharashtra and Telangana State AIDS Control Societies for their support.
Funding Information:
This project has been supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through a cooperative agreement through the United States Agency for International Development (USAID) under the terms of cooperative agreement #72038619CA00001.
Publisher Copyright:
© 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
PY - 2021/10
Y1 - 2021/10
N2 - Introduction: There are limited data on the impact of COVID-19-associated disruptions and novel HIV service delivery strategies among key populations (KPs) in low- and middle-income countries. In March 2020, in response to COVID-19, the Government of India revised HIV service delivery policies to include community antiretroviral therapy (ART) distribution and multi-month dispensing (MMD) of ART for all people living with HIV (PLHIV). Methods: To assess the acceptability of these adaptations and impact of the pandemic among KPs, we conducted focus groups in November–December 2020 with purposively sampled men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were conducted. Topics included HIV service access, risk behaviours, economic security and feedback to ensure service continuity. Inductive coding identified themes across topics. Results: Forty-four individuals aged 20–49 years participated in discussions (13 MSM; 16 FSW; and 15 TGW). Twenty-four participants self-identified as living with HIV. People not living with HIV reported challenges in accessing HIV antibody testing at hospitals due to travel restrictions and fear of contracting COVID-19. Participants accessed HIV antibody testing using transportation arranged by community-based organizations after lockdowns eased. PLHIV reported uninterrupted ART refills and generally consistent adherence; however, there were experiences of delayed CD4 and HIV RNA testing. Participants shared appreciation for MMD as it saved time, money, and reduced exposure to COVID-19. Participants expressed gratitude for home deliveries which enabled ART access, yet shared concerns about home-based services causing confidentiality breaches with family/neighbours. Participants voiced preferences for community-based service provision due to proximity, convenient hours, and welcoming environments compared to public hospitals. Other requests included support for income, employment, nutrient-rich food and more accessible mental health, HIV, and other health services. Conclusions: COVID-19 restrictions had a greater impact on access to HIV antibody, CD4, and RNA testing services compared to ART access. High acceptance of MMD and community-based services support the continued role of differentiated service delivery models to improve KP access to HIV antibody, CD4, RNA testing services, convenient ART retrieval, and integrated services beyond HIV, which may be critical for survival and wellbeing.
AB - Introduction: There are limited data on the impact of COVID-19-associated disruptions and novel HIV service delivery strategies among key populations (KPs) in low- and middle-income countries. In March 2020, in response to COVID-19, the Government of India revised HIV service delivery policies to include community antiretroviral therapy (ART) distribution and multi-month dispensing (MMD) of ART for all people living with HIV (PLHIV). Methods: To assess the acceptability of these adaptations and impact of the pandemic among KPs, we conducted focus groups in November–December 2020 with purposively sampled men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were conducted. Topics included HIV service access, risk behaviours, economic security and feedback to ensure service continuity. Inductive coding identified themes across topics. Results: Forty-four individuals aged 20–49 years participated in discussions (13 MSM; 16 FSW; and 15 TGW). Twenty-four participants self-identified as living with HIV. People not living with HIV reported challenges in accessing HIV antibody testing at hospitals due to travel restrictions and fear of contracting COVID-19. Participants accessed HIV antibody testing using transportation arranged by community-based organizations after lockdowns eased. PLHIV reported uninterrupted ART refills and generally consistent adherence; however, there were experiences of delayed CD4 and HIV RNA testing. Participants shared appreciation for MMD as it saved time, money, and reduced exposure to COVID-19. Participants expressed gratitude for home deliveries which enabled ART access, yet shared concerns about home-based services causing confidentiality breaches with family/neighbours. Participants voiced preferences for community-based service provision due to proximity, convenient hours, and welcoming environments compared to public hospitals. Other requests included support for income, employment, nutrient-rich food and more accessible mental health, HIV, and other health services. Conclusions: COVID-19 restrictions had a greater impact on access to HIV antibody, CD4, and RNA testing services compared to ART access. High acceptance of MMD and community-based services support the continued role of differentiated service delivery models to improve KP access to HIV antibody, CD4, RNA testing services, convenient ART retrieval, and integrated services beyond HIV, which may be critical for survival and wellbeing.
KW - COVID-19
KW - DSD
KW - HIV
KW - India
KW - key populations
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U2 - 10.1002/jia2.25800
DO - 10.1002/jia2.25800
M3 - Article
C2 - 34713583
AN - SCOPUS:85118349703
SN - 1758-2652
VL - 24
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - S6
M1 - e25800
ER -