Against the backdrop of COVID-19, the 21 countries in the ICAP-supported Coverage, Quality and Impact Network (CQUIN) are collaborating to support resilient HIV prevention and treatment programs in the face of the pandemic. Launched in 2017 to support South-to-South learning and the scale-up of HIV differentiated service delivery (DSD), CQUIN pivoted in 2020 to a focus on maintaining HIV services in the midst of a global crisis.

Many countries built on their earlier experience with differentiated treatment models to ensure continuity of services during lockdowns. One example is multi-month antiretroviral therapy (ART) dispensing (MMD), in which receive three or six months of ART instead of a single month’s supply. In Ethiopia, ICAP has supported the Ethiopian Ministry of Health to scale up MMD since 2017. Currently, an estimated 170,000 clients at 1,051 health facilities across the country are enrolled in Ethiopia’s Appointment Spacing Model.  Before MMD became the norm at Ethiopia’s Dessie Referral hospital, Aderaw Wegene, a construction worker, would spend time and money going back and forth between his jobs and the hospital to get his monthly ART refills. Now, after being enrolled in the new hospital program for 18 months, Wegene needs to go to the hospital only twice a year for ART. “It no longer affects my job and my life,” he said.

By mid-2020, multiple countries in the CQUIN network had expanded access to MMD in order to decrease the need for health facility visits during COVID-19. Ten countries expanded MMD eligibility, seven countries increased the amount of ART dispensed via MMD and nine enabled MMD of tuberculosis preventive treatment as well as ART. CQUIN supported cross-learning that helped to accelerate these nimble pandemic responses. For example, the ministries of health of Eswatini, Mozambique, Liberia, and Uganda leveraged lessons learned from Ethiopia to expand and scale up MMD. “This is just one example of how ICAP is leveraging the CQUIN project to foster real-time exchange of questions, resources, best practices and lessons learned,” said Miriam Rabkin, ICAP’s director of Health Systems Strategies and principal investigator of CQUIN. “Over the years, CQUIN has created a trusted and collegial network that facilitates this type of rapid and productive exchange.”

Funding: The Bill & Melinda Gates Foundation