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Title
Fast-tracking treatment optimization to address treatment continuity among PLHIV through comprehensive approach and use of digital and telehealth platforms during the COVID -19 pandemic in Andhra Pradesh, India
Presenter
Reshu Agarwal
Authors
R. Agarwal1, P. Turaka2, A. Rajendran2, U. Krantha2, N. Chava2, G. Ramesam2, A. Rao2, P. Kumar2, R. Allam1, R. Prasad2, V. Yeldandi2, A.E. Florence3, M. Nyendak1, K. Prasad3
Institutions
1U S Centers for Disease Control and Prevention, Division of Global HIV and TB, Delhi, India, 2Society for Health Allied Research & Education India, Hyderabad, India, 3Andhra Pradesh State AIDS Control Society, Vijayawada, India

BACKGROUND: Transition to DTG based regimens (DTG) in India coincided with the devastating second wave (April to June 2021) of COVID-19 pandemic. With urgency for transition to DTG due to depleting stock of the previously used ART regimens and lockdown that hit the mobility, it was critical to devise comprehensive approach to address treatment continuity and fast-track ART optimization.


DESCRIPTION: Between April to June 2021, we adopted multi-pronged strategy to fast track DTG transition in 13 districts of Andhra Pradesh (Figure) including–- mapping of all PLHIV eligible for transition to DTG by sub-district unit using epidemiological tools; engagement with all stakeholders for preparation of transition plan; proactive outreach of PLHIV for transition to DTG through digital modalities such as phone follow-ups, text messages and interactive voice response systems; teleconsultation sessions; and physical camps for PLHIV at decentralized and remote locations who couldn’t reach the ART sites due to restricted mobility. In addition, we prepared job-aids and education material on DTG for ART staff and PLHIV, ensured drug supply chain and monitored the progress of transition daily.


LESSONS LEARNED: During the surge period (April-June 2021), 80,553 of 186,170 PLHIV receiving ART (43%) were transitioned to DTG-based regimens, of which 49,405 (61.3%) PLHIV reached ART clinics for transition subsequent to the digital outreach; 19,718 (24.5%) were transitioned through teleconsultation modalities; and 11,430 (14.2%) through decentralized camps.
CONCLUSIONS: Transition to DTG-based regimen was feasible amidst the peak of COVID-19 through the sequential and coordinated approach, including use of digital and telehealth platforms, for a sustained treatment continuity. Further, telehealth models have potential to reach the PLHIV residing in remote locations and provide them appropriate management, thereby enhancing health equity. Sustaining and scaling up telehealth care models for HIV service delivery could ensure enhanced access to services while maintaining continuity to care and treatment for PLHIV.

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