Interim Guidance for Continuing HIV Program Service Delivery During COVID-19 Pandemic

Overview

The National Center for National Centre for AIDS and STD Control (NCASC) has updated it’s guideline on Interim Guidance for Continuing HIV Program Service Delivery During COVID-19 Pandemic.

The main objective of this document is to prevent community workers, healthcare workers and beneficiaries from COVID-19 infection while serving/ giving services and able to combat HIV transmission, retain on treatment and achieve the national goal during this pandemic. 

Inside this;

• Situation of HIV epidemic in Nepal
• General information on COVID-19
• How to prevent from COVID-19 infection?
• COVID-19 and HIV service delivery continuity
• Information for front line workers working in Prevention, Diagnosis, Treatment, Care and Support for HIV program
• Hand hygiene and respiratory hygiene are key to COVID-19 prevention measures in addition to physical distancing
• HIV Prevention Program Diagnosis of HIV
• 8 Differentiated HIV testing services (HTS) in COVID-19 Context ART center
• VL Sample Collection and Testing
• Community providers services for PLHIV
• Guidance for management of Harm reduction program for PWID
• Opioid Substitution Therapy (OST)
• Needle Syringe Program (NSP)
• Communication during Covid-19 response

IMPACT OF COVID-19 ON HIV

During initial days of COVID pandemic, HIV infection was not considered as a risk factor for COVID-19 or more severe disease. However, recent studies conducted in larger samples suggest that PLHIV (particularly with low CD4 counts or not under ART) if infected with COVID are more likely to have severe clinical course in comparison to HIV negatives (Ambrosioni et al 2021).

Moreover, the COVID-19 pandemic has hugely disrupted HIV prevention and treatment services globally and created challenges to continue the essential service delivery. A recent modelling study suggests that in sub-Saharan Africa a 6-month interruption of ART would result in an excess of 500 000 adult deaths from HIV infection during a 4-year period and an up to twofold increase in mother-to-child transmission of HIV.

To maintain an effective HIV response during the COVID-19 pandemic, it is important to continue essential services such as providing early testing, implementing preventive measures among KPs, including harm reduction, and ensuring continuity of ART. WHO has enlisted HIV programs as an essential health service to be continued during COVID pandemic.

How to prevent from COVID-19 infection?

To prevent from acquiring COVID-19, everyone including PLHIV, Key Population, Community workers and health care workers providing services to these population should routinely follow practices mentioned below:

1. Immunization against COVID-19, whenever possible (The currently available vaccines are safe for all including PLHIV)
2. Avoid overcrowding and maintain social distancing (at least 2 metres)
3. Do not touch eyes, nose and mouth with unclean hands
4. Wash hands regularly with soap and water properly for at least 20 seconds. If the soap and water is not available, use sanitizers (alcohol based) instead. Hand washing and use of sanitizers should be done as frequently as possible.
5. Clean the high touch surface area of the house and working area (such as table tops, door knobs etc.) with disinfectants
6. When sneezing and coughing cover the mouth and nose with elbow and if tissue is used to cover the mouth and nose, immediately dispose the tissue paper in proper place such as closed bins
7. Do not spit in the open place.
8. Visit to health facilities should be minimized or avoided unless absolutely necessary
9. In case of severe health conditions like shortness of breath, and other critical conditions, clients should be taken immediately to the health facility
10. Everyone must follow the national public health standard for COVID-19 (SMS); Social distancing, use of mask (cloth mask or medical mask) and Sanitizer.

COVID-19 and HIV service delivery continuity

As Nepal, like many other countries in the world is tackling the COVID-19 pandemic, it is equally important to ensure that HIV essential services are not interrupted, and HIV prevention is maintained while battling with COVID-19 response and all PLHIV are retained on treatment. The NCASC has developed and updated this interim guidance to assist the National HIV programme, health personal and PLHIV for continuity of services during this Pandemic situation. All possible measures should be implemented to ensure that HIV key populations and PLHIV get continued services under safe conditions applying core human rights principles.

Recommended readings

• Ending AIDS Together !! International AIDS Candlelight Memorial 2017
• Candlelight Memorial 2019: Intensifying the fight for Health and Rights!
• Candlelight Memorial 2016: Engage, Educate, Empower! (Event of the Week)
• National Centre for AIDS and STD Control (NCASC)
• UNAIDS calls on countries to step up global action and proposes bold new HIV targets for 2025
• UNAIDS calls on countries to step up global action and proposes bold new HIV targets for 2025
• HIV Standard Service Package (SSP) For Key Populations
• HIV Epidemic Update of Nepal (Fact sheet 2020)
• UNAIDS calls on countries to step up global action and proposes bold new HIV targets for 2025
• The Joint United Nations Programme on HIV/AIDS (UNAIDS) Data 2019
• Interim Guidance for Continuing HIV Program Service Delivery During COVID-19 Pandemic
• Interim Guideline for Malaria Program During COVID-19 in Nepal (Updated)