Expanding access to HIV services during the COVID-19 pandemic—Nigeria, 2020
Authors: Boyd Andrew T. , Jahun Ibrahim , Dirlikov Emilio , Greby Stacie , Odafe Solomon , Abdulkadir Alhassan , Odeyemi Olugbenga , Dalhatu Ibrahim , Ogbanufe Obinna , Abutu Andrew , Asaolu Olugbenga , Bamidele Moyosola , Onyenuobi Chibuzor , Efuntoye Timothy , Fagbamigbe Johnson O. , Ene Uzoma , Fagbemi Ayodele , Tingir Nguhemen , Meribe Chidozie , Ayo Adeola , Bassey Orji , Nnadozie Obinna , Boyd Mary Adetinuke , Onotu Dennis , Gwamna Jerry , Okoye McPaul , Abrams William , Alagi Matthias , Oladipo Ademola , Williams-Sherlock Michelle , Bachanas Pamela , Chun Helen , Carpenter Deborah , Miller David A. , Ijeoma Ugonna , Nwaohiri Anuli , Dakum Patrick , Mensah Charles O. , Aliyu Ahmad , Oyeledun Bolanle , Okonkwo Prosper , Oko John O. , Ikpeazu Akudo , Aliyu Gambo , Ellerbrock Tedd , Swaminathan Mahesh 
Published: September 2021

Abstract
Background
To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February–September 2020.

Methods
Adapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3–6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring.

Results
During February–September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%.

Conclusions
A rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic.