Interventions to improve headcount during covid-19 lockdown in South Africa

ABSTRACT

Background: The world was overcome by the COVID-19 pandemic from late 2019. South Africa entered into a country wide lockdown level 5 from March 26 to April 16, 2020. Public health facilities were greatly affected as they experienced reduced facility headcounts, which resulted in reduced HIV testing services (HTS), reduced patients attending their follow-up visits, and this also impacted the viral load completions. Methods: This was a retrospective review that analyzed the trends and the impact COVID-19 had on the headcount of primary health care (PHC) facilities and the number of patients accessing HTS and the Total Remaining on ART (TROA). In order to view the facility headcount and HTS trends on the same scale, for graphical representation the monthly figures have been indexed to their values in July 2019 (Jul 2019 = 100), prior to the impact of COVID-19 and the typical seasonal decline in activity during the holiday period. Results: Facility headcount dropped during the COVID-19 period (Mar 20, 0.98 to Apr 20, 0.73);and it is clear that the HTS trends (Mar 20, 0.89 to Apr 20, 0.47) mirror the headcount trends (Figure 1). However, the total remaining on ART remained relatively stable during this period;demonstrating successful programme efforts towards retention. These activities included case management of clients, community ART delivery, SMS reminders, extension of CCMDD (Centralised Chronic Medication Dispensing and Distribution) scripts, multi-month scripting and dispensing, improved appointment systems in facilities where we had filing interns, data quality improvement activities during this period and daily tracking with the district teams. Historically we have seen that HTS habitually drops during the holiday periods of December and April but starts picking up and follows the headcount trends. This year Level-5 lockdown brought on a steep drop with a strong recovery once lockdown restrictions eased, albeit not totally to former levels. Conclusion: Therefore, despite drastic drops in headcount from April 2020 to September 2020 as compared to 2019, the stability of TROA shows that implemented retention strategies have had a positive impact on the retention of patients during a pandemic.