Robust progress in ARV optimization for older adolescents and adults despite COVID-19

Rachel Golin1, B. Ryan Phelps1*, Christine Y. Malati1*, Daniel Kiesa1*, Miriam Hartig1*, Jeffrey M. Samuel1,  George K. Siberry1

*These authors have contributed equally to the work.

1
Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA

BACKGROUND
PEPFAR prioritizes the WHO-recommended uptake of dolutegravir [DTG]-based regimens for people living with HIV
(PLHIV). In October 2019, PEPFAR began semi-annual monitoring of ARV volumes dispensed.  We sought to understand the
trend in ARV optimization for PLHIV ≥ 15 years old (PLHIV15) during the COVID-19 pandemic.

DESCRIPTION

PEPFAR, through USAID, supported nearly 5.9 million* PLHIV15 in  over 40 countries at the end of September 2020.
Programs adapted to continue transition to fixed-dosed combination tablet containing tenofovir/lamivudine/dolutegragir (TLD)
during COVID-19. Clinical partners adjusted HCW training platforms to promote rapid transition to DTG-based regimens. To
mitigate commodity disruption, staff developed tools and processes to expedite delivery of products with higher shelf life and
optimize cargo and storage space.
*Data updated since initial abstract submission.
LESSONS Figure 1: TLD uptake among PEPFAR-supported, through USAID, PLHIV ≥ 15 years of
age at the end of March 2020 (USG FY20 Q2) and the end of September 2020 (USG FY20
Despite tremendous COVID-19 related Q4), excluding Asian, West Africa, and West Hemisphere regional programs.
challenges, substantial gains in TLD uptake were
made.  From March to September 2020,
PLHIV15 on ART in USAID-supported
programs increased in 16 of 18 countries. More
than 85% of all TLD orders affected by COVID-
19 arrived on time.

ARV dispensing data reveal that all countries

except Zambia and DRC increased the
percentage of USAID-supported PLHIV15
receiving TLD (Fig. 1). To decongest facilities in
Zambia, clinics provided clients with a six-
month supply of TLE400 before transitioning
clients back to TLD by late 2020. TLD coverage
in DRC declined slightly but remained
Figure 2: Trend in increased stock availability of TLD as NNRTI-based products decline for
extraordinarily high (98%); TLD coverage in eight countries (Botswana, Haiti, Lesotho, Mozambique, Namibia, Nigeria, Uganda and
four other countries (Haiti, Mozambique, Zambia).
Nigeria, South Sudan) exceeded 90% by the end
of September 2020. TLD coverage more than
doubled in the Dominican Republic, Lesotho,
Mozambique, South Africa and Zimbabwe.

Product stocking level analysis from eight

countries revealed fewer non-nucleoside reverse
transcriptase inhibitor (NNRTI) products and
increased DTG products, reflecting increased
dispensing of optimal regimens (Fig. 2).
Inventory status for these countries was
sufficient for continued ART optimization.

CONCLUSIONS

Program adaptation, including monitoring and preservation of ARV stock, allowed millions of PLHIV15 to receive TLD
despite COVID-19 disruptions. Continued, proactive implementation and strategic supply chain adjustments are needed to
ensure all PLHIV can access the benefits of DTG.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Agency for International Development, the U.S. President's Emergency Plan for AIDS Relief, or the United States
Government. This abstract was made possible by the support of the American people through the United States Agency for International Development under the U.S. President's Emergency Plan for AIDS Relief.

PRESENTED AT IAS 2021 – the 11th IAS Conference on HIV Science|18-21 JULY 2021