Creating opportunities out of challenges: assessment of adaptations to maintain uninterrupted access to antiretroviral therapy for HIV clients in West Africa during the first year of the COVID-19 pandemic

The COVID-19 pandemic imposed challenges to HIV service provision in Africa. The Ending AIDS in West Africa project (#EAWA), implemented in Burkina Faso and Togo, took measures to mitigate service provision disruptions due to COVID-19. We document the project’s strategies for ensuring an uninterrupted service provision to people living with HIV (PLHIV) during the COVID-19 pandemic. Using reports from project staff, we summarized #EAWA’s service provision strategies during the pandemic. This finding was complemented by a descriptive analysis of routine program data collected from December 2019 to April 2021 to evaluate how well these measures performed. COVID-19-related travel restrictions, lockdowns, logistical challenges, and fear of health facilities restricted access to HIV care. Building on shifting policy environments in both countries, #EAWA adopted a contingency plan to accelerate the multi-month dispensing of ARVs (MMD) and differentiated drug delivery (DDD). Quantitative results show that the pandemic briefly disrupted ARV refills and MMD dispensation. The implementation of EAWA’s contingency plan corresponded to a rapid increase in drug refills and MMD in both countries. Examination of programmatic data from this HIV program shows that COVID-19 provided the impetus to embrace MMD to ensure continuity of care. Despite an extremely challenging and shifting environment, the #EAWA project was able to respond nimbly to ensure clients stayed on treatment.