The COVID-19 pandemic brought with it the risk of significant challenges for people living with HIV (PLHIV) who need antiretroviral treatment (ART). Uninterrupted access to ART is the key to staying healthy and keeping the virus under control so it cannot be passed on to partners. Clinical studies clearly show that interruptions in ART can have dangerous long-term consequences.
For some time, nongovernmental organizations (NGOs) and international agencies have been advocating that PLHIV should be given several months of their medication at a time; however, there were concerns about patients who might not have safe dry places to store medicines and might not keep to their treatment plan without more frequent monitoring. With the start of the COVID-19 pandemic, there have been lockdowns and limitations on health-care visits, as per WHO recommendations, and many countries have opted to provide 3–6 months of ART at a time. Early feedback has shown that concerns can be resolved through cooperation between governmental institutions, NGOs, health workers and community-based groups. In addition to multi-month dispensing of medicines, digital platforms and phone calls or home visits have been introduced to make sure PLHIV receive the clinical and mental health support they need during the pandemic.
Dr Nino Berdzuli, Director of Country Health Programmes at WHO/Europe commented positively on the developments as a good example of the WHO policy framework “United Action for Better Health in Europe”: “This people-centred approach to providing care demonstrates the importance of protecting and promoting the health of the most vulnerable – such as those living with a stigmatized disease – and using innovative approaches, such as digital platforms, to maintain or enhance service provision. Although not all countries have been able to prescribe or assure multiple month supplies of ART due to limited stocks or risk of facing stock outs due to procurement and supply challenges, the way countries are approaching this is clearly moving in the right direction”.
Medication difficulties when stranded due to the pandemic
Travel disruptions and border closures caused by the pandemic have also led to people finding themselves stuck in unexpected places, unable to get medication or simply running out of essential medicines they normally bring from a home country.
Life4me+ is an international community-based NGO that has been working with WHO/Europe and other partners in the European Region to help PLHIV who have found themselves stranded abroad during the pandemic with a dwindling supply of vital medicine.
Dr Alex Schneider is the President of the Life4me+ Board. “At the beginning of the pandemic, we were receiving enquiries from tourists who were unable to get home from various countries in Asia and found they were running out of medication,” he explained. “Then things shifted and we found increasingly we were hearing from people in Europe, so called labour migrants, who were getting their medicines from their home countries. When this happens, we are able to put them in contact with sympathetic physicians and explain to them what their rights are. Often people are scared that a clinic or a doctor will tell their employer they are HIV positive; we can reassure them that they are not allowed to do that. People are often amazed that they are actually entitled to care in the country they are living in and do not have to bring medication with them from home.”
During the pandemic, Life4me+ has had to supply medication directly in some cases, to people working illegally or without health insurance, or to stranded tourists. WHO was able to facilitate this by supplying a donation of medication from warehouse reserves held by the Organization and other United Nations agencies. This covered a part of the common regimens (tenofovir/emtricitabine and tenofovir/lamivudine) and ensured fast delivery.
The pandemic as a catalyst for change
Dr Masoud Dara, Coordinator for Communicable Diseases at WHO/Europe, said: “We at WHO/Europe are pleased to have been able to intervene fast and help Life4me+ support people stranded without medication. The COVID-19 pandemic has been a difficult time for everyone, but it is encouraging to note that it has been a catalyst for change in the way HIV treatment services are delivered. Continuing scaling up of ART will mean integrating HIV services into the public health system — in many cases, down to primary health care and community-based facilities — in order to increase access for patients and communities. This pandemic has proved that communities are best placed to reach those most in need of ART and ensure that no one is left behind”.