BACKGROUND: Mumbai has an estimated HIV prevalence of 0.34% and is a destination for migrants from all over India. With the COVID-19 pandemic and sequential lockdowns, many People Living with HIV (PLHIV) who migrated to Mumbai receded to their place of residence outside Mumbai, creating a challenge for Antiretroviral therapy (ART) continuity.
METHODS: During March 2020, we pre-emptively generated list of PLHIV due for their pill-pick-up and reached out by phone to all PLHIV (N=38,577) from 20 ART centres in Mumbai. We developed e-transfer protocols facilitating ART pick-up for ‘out’ migrant clients accessing ART services at alternate location. From July to December 2020, we rapidly established decentralized dispensation sites, ART home delivery, and drafted standard operation procedures for tracking and tracing PLHIV from inter and intra-state locations. We defined Lost-to-follow-up (LFU) as no pill pick-up for >28 days from the last expected pick-up. We calculated the number of PLHIV returned to treatment [RTT: LFU during April-June 2020 and successfully restarted ART and remained on ART between Sept 2020 to 2022).
RESULTS: From April to June 2020, we observed LFU rate of 11.7% (4,497/38,577) in Mumbai. The median age of LFU cohort (4,497) was 38 years, 60% (2,702) were males and 47% (2,114) migrants. Of the 78% (3,509/4,497) who RTT, 77% (n=2,701/3,509) were on ART for > 2 years prior to LFU. With the implementation of multiple strategies 83% (2,908/3,509) of RTT returned within 6 months after LFU during peak COVID. The majority [57%, (564/988)] who could not return to treatment were on ART for <6 months prior to LFU.
CONCLUSIONS: Through specialized tracking and tracing efforts in Mumbai serving higher migrants we observed high return to treatment during the first nine months and continued returns even after nine months of LFU.

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