ABSTRACT
Background: In March 2020, the World Health Organization declared COVID-19 a pandemic. On March 21, the Ugandan government instituted a nationwide lockdown, suspending public transport and closing schools and businesses. This threatened to interrupt antiretroviral therapy (ART) service delivery to people living with HIV (PLHIV) in urban areas and those who had traveled away from home. We describe how the Infectious Diseases Institute (IDI) ensured continued HIV service delivery in Kampala, Uganda. Methods: IDI serves 215,427 PLHIV receiving ART in Kampala and Wakiso districts. From April to June 2020, IDI scaled up multi-month ART refills and contacted PLHIV by phone to tailor ART refill delivery options to ensure uninterrupted access. Options included home or specified community point delivery in which expert clients using motorcycles made deliveries (a modality adopted by the ministry of health in Uganda);referrals to health facilities within walking distance of clients' lock down locations;drug pickup by a designee;and, for PLHIV receiving third-line ART, refill delivery via the national laboratory sample transport system. IDI also launched the Kampala Capital City Authority COVID-19 hotline and CDC-supported toll-free line so that PLHIV could seek guidance on how to access treatment. To avoid service interruptions due to reduced public transportation for staff, IDI provided transport for selected health workers to and from the health facility. Results: During the lockdown, of the 191,576 PLHIV with scheduled visits, 105,037 (55%) missed their appointment and required immediate follow-up. A total of 205,296 PLHIV received an ART refill. Through IDI's efforts, 194,873 (those who had missed appointments and unscheduled walk-ins) were reached. Most (177,433 [86%]) were served at their routine facility, 17,440 (8%) received refills in the community, and 10,423 (5%) received refills at facilities outside the region. Only 51,589 (26%) received 3- or 6-month refills. Conclusion: With innovations and program modification, IDI ensured continuity of ART services in an urban population during the lockdown. Scale-up of multi-month refills may be needed during the COVID-19 pandemic and future emergencies to ensure uninterrupted ART services for PLHIV. Tailored refill options for HIV service delivery can improve retention.