(P53) Maintaining access to HIV services to persons living with HIV amid the COVID-19 pandemic in Nepal

Project: The National Centre for AIDS and STD Control (NCASC) practiced innovative strategies with the objective of ensuring uninterrupted access to HIV services amid the COVID-19 pandemic in Nepal. Innovations were practiced since June 2020 through May 2021 in the HIV centers of high burden districts based on key population estimates, HIV prevalence and COVID-19 hotspot mapping. During the period of travel restrictions, risk assessment was conducted virtually to the key populations. NCASC initiated travel pass program to support organizations that provide needle syringe exchange and opioid substitution therapy. Antiretroviral drugs were delivered at home through networks of people with HIV.



Issue: The surge of COVID-19 infection and subsequent lockdown resulted in closure of many public and private health facilities, including those providing HIV services. While the national prevalence of HIV was 30300 in 2020, many persons with HIV could not continue to access services from the routine health facilities. The targeted beneficiaries of the project included people with HIV, pregnant women, HIV infected infants and children, and people who inject drugs.



Results: Nearly 50% of the targeted clients benefited by the interventions. A total of 8542 virtual consultations were conducted. Through travel pass program, 2702947 syringes were distributed; benefiting 3364 people who inject drugs. Through the same program, 328 people received methadone and 92 people received buprenorphine. Among the 20883 people with HIV on ART, 9900 received home delivery of ART. This program included 157 (73%) pregnant women with HIV, 121 (56%) mothers with HIV and 900 (71%) HIV infected infants and children. The activities of the project were feasible and were acceptable by the communities while lockdown had imposed barriers to access to most HIV services.



Lessons learned: Virtual consultations, travel pass program and home delivery of medicines were effective strategies of maintaining continuity of HIV services amid the COVID-19 pandemic in Nepal. Similar programmatic models can be implicated to other health conditions that require long-term care during the situations like the COVID-19 lockdowns that impose substantial barriers to access to health services. Supportive policies are needed for sustainability of such services in communities.