Utility of Digital Solutions in Sustaining Access and Improving Efficiency of Hiv Vl

ABSTRACT

Background: Coronavirus Disease 2019 (COVID-19) pandemic disrupted routine program implementation worldwide with significant impact on quality and extent of technical oversight of implementation. Diverse digital reporting solutions and online meetings were some strategies designed to bridge program implementation supervision and reporting gaps worldwide. This paper evaluates usefulness and efficiency of digital solutions deployed by USAIDNigeria to ensure adequate oversight to sustain access and reporting of HIV viral load (VL) services Methods: To promote accountability and encourage peer-to-peer review and learning among USAID Implementing Partners, daily reporting via digital platforms and virtual weekly peer-review meetings were introduced. This enabled USAID team to monitor IPs' performance at health facilities and during community VL drives against set targets of 100% and 95% patient VL coverage and suppression (VLC/S) respectively. The platforms include National Laboratory Information Management System, remote sample login and Googlebased VL Status and Daily Lab Performance dashboards. This study assesses uptake of VL services and clinical outcomes in 16 states of Nigeria between October2019 through March2021 during various levels of COVID-19 lock down. Chi Square test was used to compare the pre-COVID (October2019-March2020), during lockdown (April2020-September2020) and post-COVID lockdown (October2020-March2021) performances at 95 confidence interval and < 0.05 level of significance. Result(s) Significant improvements in VL indicators were reported among eight USAID partners across 16 states. Pre-COVID, 591,906 clients on treatment were eligible for VL monitoring, 455,099 were tested and had documented VL results with a 76.9% and 89% VLC/S. During-COVID lockdown, 685,915 became eligible for VL monitoring, 531,371 had documented VL results, with 77.5% and 90% VLC/S. VLC/S increased to 93% each post-COVID lockdown, when 771,149 had documented VL out of 833,463 eligible. There was a significant increase number of clients on treatment who became eligible for VL test and had documented VL results and suppression from pre- during-COVID, and post-COVID lockdown (p=0.001) Conclusion(s) Digital solutions deployed by USAID were instrumental to sustaining service delivery with significant growth in access and efficiency to HIV VL services in 16 States in Nigeria despite impact of COVID-19. Program managers should continue to explore cost-efficient innovative approaches for program oversight.