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Pollard R, Gopinath U, Reddy YA, Kumar BR, Mugundu P, Vasudevan CK, Srikrishnan AK, Singh A, McFall AM, Mayer KH, Mehta SH, Solomon SS. HIV service delivery in the time of COVID-19: focus group discussions with key populations in India. J Int AIDS Soc 2021; 24 Suppl 6:e25800. [PMID: 34713583 PMCID: PMC8554214 DOI: 10.1002/jia2.25800] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction There are limited data on the impact of COVID‐19‐associated disruptions and novel HIV service delivery strategies among key populations (KPs) in low‐ and middle‐income countries. In March 2020, in response to COVID‐19, the Government of India revised HIV service delivery policies to include community antiretroviral therapy (ART) distribution and multi‐month dispensing (MMD) of ART for all people living with HIV (PLHIV). Methods To assess the acceptability of these adaptations and impact of the pandemic among KPs, we conducted focus groups in November–December 2020 with purposively sampled men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were conducted. Topics included HIV service access, risk behaviours, economic security and feedback to ensure service continuity. Inductive coding identified themes across topics. Results Forty‐four individuals aged 20–49 years participated in discussions (13 MSM; 16 FSW; and 15 TGW). Twenty‐four participants self‐identified as living with HIV. People not living with HIV reported challenges in accessing HIV antibody testing at hospitals due to travel restrictions and fear of contracting COVID‐19. Participants accessed HIV antibody testing using transportation arranged by community‐based organizations after lockdowns eased. PLHIV reported uninterrupted ART refills and generally consistent adherence; however, there were experiences of delayed CD4 and HIV RNA testing. Participants shared appreciation for MMD as it saved time, money, and reduced exposure to COVID‐19. Participants expressed gratitude for home deliveries which enabled ART access, yet shared concerns about home‐based services causing confidentiality breaches with family/neighbours. Participants voiced preferences for community‐based service provision due to proximity, convenient hours, and welcoming environments compared to public hospitals. Other requests included support for income, employment, nutrient‐rich food and more accessible mental health, HIV, and other health services. Conclusions COVID‐19 restrictions had a greater impact on access to HIV antibody, CD4, and RNA testing services compared to ART access. High acceptance of MMD and community‐based services support the continued role of differentiated service delivery models to improve KP access to HIV antibody, CD4, RNA testing services, convenient ART retrieval, and integrated services beyond HIV, which may be critical for survival and wellbeing.
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Affiliation(s)
- Rose Pollard
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Usha Gopinath
- YR Gaitonde Center for AIDS Research and Education, Chennai, India
| | - Yeruva A Reddy
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bogam R Kumar
- YR Gaitonde Center for AIDS Research and Education, Chennai, India
| | - Parthasarathy Mugundu
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Aditya Singh
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison M McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.,Fenway Health, The Fenway Institute, Boston, Massachusetts, USA
| | - Shruti H Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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