Title

Learning from COVID 19 inspired ART client management innovation: a comparison of retention and viral load suppression between 1 and 3 months dispensation at ART initiation in Zambia

Presenter

Lackeby Kawanga

Authors

L. Kawanga¹, J. Posner², A. Ndhlovu¹, M. Nyumbu¹, M. Musonda³

Institutions

¹JSI, Center for HIV and Infectious Diseases, Ndola, Zambia, ²JSI, Center for HIV and Infectious Diseases, Bostone, United States, ³USAID, Zambia, Health Department, Lusaka, Zambia

BACKGROUND: COVID 19 pandemic posed a threat to the gains that were made in HIV treatment programs. HIV treatment programs require that newly diagnosed People Living With HIV (PLWHIV) are dispensed 1 month or less of ARVs to enable them receive adherence counseling frequently in order to achieve optimal retention in the long run. The Zambian ministry of health promoted 3 Multi-Month Dispensation (3MMD) to newly diagnosed PLWHIV in March 2020 to mitigate the risk of COVID 19 infection. After more than 2 years of implementation, the question on whether this undertaking did produce desired treatment outcome comparable to those under standard of care begs to be answered.
METHODS: The USAID DISCOVER-Health Project, implemented by JSI, used retrospective data from a cohort of PLWHIV initiated on ART in December 2021, in Ndola district. Data analysis was done to compare proportions of retention in care and viral load suppression at 12 months between clients dispensed 1 and 3 months of ARVs at initiation. Retention was defined as proportion of clients with less than 30 consecutive days without ART at any point during follow-up, while suppression was defined as having <1000 copies per mL at 12 months in care.
RESULTS: Of the 241 who were initiated on treatment in December 2021, 146 were females while 95 were males, with mean age of 35 years. At ART initiation 44% received 1 Month Dispensation (1MD) while 56% were supplied 3 months. Retention in care rates at 12 months was higher in the 3MMD at 90% compared to the 1MD at 82%. Viral load suppression at 12 months was at 96% for the 1MD compared to 97% for the 3MMD.
CONCLUSIONS: The 3MMD was capable of producing the desired treatment outcome comparable to those under 1MD, with retention in care performing better than the 3MMD. This finding is important to countries like Zambia that are trying to simply further HIV management and provide person centered care. With continuity in treatment being better in 3MMD than 1MD, 3MMD may have an important role to play in ART care in the first critical year.

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