Protecting  HIV Services During COVID-19

How has COVID-19 affected the global fight to end AIDS?

Recently, Rhoda Igweta, Associate Director of Public Policy and Advocacy at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), sat down (over Zoom) to chat with John Ditekemena, MD, MPH, PhD, the Country Director of EGPAF-Cameroon, about how operations and programs have modified to meet the challenges of COVID-19. Previously, Dr. Ditekemena was the country director of EGPAF-Democratic Republic of Congo for more than nine years.

This is Part I of the conversation. Read Part II here.

Rhoda Igweta: So how is COVID-19 affecting access to HIV services at the beneficiary level in Cameroon? Do you think that it will have any impact on the trend towards ending AIDS in infants and families?

John Ditekemena: EGPAF Cameroon has been experiencing challenges across our programs. For instance, we have been experiencing a drastic drop in terms of case identification. That is due to the fact that patients are afraid to go to the facilities because some of the major facilities have been assigned as COVID-19 facilities. When you are taking care of COVID-19 patients, other patients are scared to go to that facility to seek care.

Some of those who are HIV-positive on treatment are afraid to go to the facility to collect the treatment. This has affected adherence to treatment and, thus, the number of people with suppressed viral load. John Ditekemena

We have been really struggling to reach our target with regards to HIV index testing. I can take the example of the Littoral region of Cameroon: Prior to COVID-19, we had been testing about 200 new HIV-positive patients each week, but we have since dropped by half—so we have been testing just 100 per week. One reason is that providers are afraid to take more time with the patient because they don’t want to be exposed to COVID-19.

In addition, some of those who are HIV-positive on treatment are afraid to go to the facility to collect the treatment. This has affected adherence to treatment and, thus, the number of people with suppressed viral load.

Last, we have trouble tracking viral load results because most of the big facilities that conduct viral load testing have also been assigned to conduct COVID-19 testing. Those laboratories have prioritized COVID-19 samples compared to HIV, which caused a delay in a viral load testing.

Rhoda Igweta: What measures are we taking to protect mothers and infants during this time, so that they can access HIV services? 

John Ditekemena: For infants and mothers, HIV services have been negatively impacted, but we have taken measures. One strategy is to provide services at what we call a “satellite site.” Since clients were afraid to go to big facilities, we identified some small facilities, and we reinforced the capacity there to provide prevention of mother-to-child HIV transmission (PMTCT), multi-month dispensing of HIV treatment, counseling, and other HIV services.

Since clients were afraid to go to big facilities, we identified some small facilities, and we reinforced the capacity there to provide HIV services. John Ditekemena

We also use the phone. We use SMS [text messaging] and WhatsApp groups to link clients and to share information.

For those who have bigger issues, we have community-focused health workers and volunteers who are linked to the Ministry of Health and can conduct home visits—respecting all the COVID-19 preventive measures. When they go to the community for HIV activities, we can use that opportunity to integrate COVID-19 education.

Rhoda Igweta: How do you manage the ongoing work of EGPAF while keeping our staff, clients, and the frontline health workers safe? 

John Ditekemena: This has been very challenging. You have people who need to continue to deliver services, both health workers and EGPAF staff. We have had a total of 33 EGPAF staff infected with COVID-19. And I remember receiving information that in one of our facilities almost 60% of the staff were quarantined at one time.

As a country director, I conducted one-on-one discussions with all those who were quarantined, just to let them know that we are fighting this disease together. John Ditekemena

We put in place some standard operating procedures. For example, at the facility level, we put in place a rotation plan to avoid to putting a lot of staff in the same space or the same facility, to make sure that those are working today are not the same ones working the next day so that we reduce staff exposure to COVID-19.

We also put in place online contact-tracing for all the EGPAF staff, and we also identified those staff who were at highest risk and could work from home. For example, we managed to remove those who have some chronic disease like hypertension or diabetes from the facility.

Those staff who were exposed to COVID-19 were put in quarantine. If they did not fall sick they could continue to work from home. Those who became sick took the appropriate protocols. Fortunately, we’re lucky: COVID-19 did not take the life of any EGPAF staff.

As a country director, I conducted one-on-one discussions with all those infected and those who were quarantined, just to let them know that we are fighting this disease together. And we used our partner INOVA to provide psychosocial support.

I can say the morale is higher now, but not yet at the level prior to COVID-19. But we are beginning to succeed again. For instance, I convinced the Ministry of Health and the National AIDS Control Program to start reimplementing community activities now that lockdown has been relaxed. Our performance is improving. We hope to soon reach previous levels for identifying and treating people living with HIV.