Sustaining Methadone Treatment During Lockdown

While the advent of the COVID-19 pandemic in early 2020 dominated the attention of global public health, the challenge of treating drug addiction and HIV – often co-occurring –  was only complicated by fear of COVID-19 and the necessary restrictions imposed by governments to prevent transmission.

The Kyrgyz Republic is one of three countries in Central Asia, along with Kazakhstan and Tajikistan, where ICAP has been working since 2011, supporting HIV and tuberculosis services, particularly for people who inject drugs. In this context, ICAP’s focus shifted to ensuring that hard-won health gains to reach vulnerable populations in Kyrgyzstan would not be set back by the new pandemic.

In the context of the COVID-19 lockdown, the protocol in Kyrgyzstan for patients using medication-assisted therapy (MAT) to control their drug addiction needed to be rapidly transformed. The usual requirements involved the need for the clients to visit an MAT clinic every day for counseling and receive a limited supply of methadone. After six months, if the client met certain criteria, including negative urine tests and consistent medication usage, then the MAT site would issue an increased supply so clients could take the medication at home.

After the Kyrgyz government declared a state of emergency on March 22, 2020 in response to the worsening COVID-19 situation, ICAP collaborated with the Ministry of Health’s Republican Narcology Center (RNC) on plans to keep clients in MAT treatment, while minimizing the need for travel during the national quarantine and the risk of exposure to COVID-19. As part of these COVID-19 preventive measures, the RNC began to increase the number of MAT clients in Kyrgyzstan permitted to take home up to five daily doses of methadone supply.

“After almost nine months, we have seen great success with this new protocol and the proportion of clients on MAT who pick up methadone for 5-7 days increased from 36% to 97%.”

Ainagul Isakova,
ICAP program coordinator in Kyrgyzstan
Working out the logistics to implement this new policy during the pandemic required thoughtful planning. While travel throughout the country was restricted, each client was given reference and route sheets that serve as authorization that they could to show to law enforcement officials at roadblock posts. MAT sites were also provided with a supply of personal protective equipment, hand disinfectants, remote thermometers and additional mobile phone units. ICAP also worked with MAT specialists at the RNC to streamline methadone distribution using QR codes, another example of ICAP’s continuing pursuit of innovative solutions to emerging global health needs.

Funding: The Global Fund to Fight AIDS, Tuberculosis, and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)

INVENTIVE

PREVENTIVE

SUSTAINABLE

The Power of PrEP Video

Introducing and Scaling Up HIV Service Delivery Models

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.

Q

Introducing and Scaling Up HIV Service Delivery Models

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

More Impact Stories

STORY 1

Pivoting to Protect Vulnerable Populations

As news of the discovery of a new coronavirus broke, the outbreak in China was rapidly followed by devastating impact in Italy, France and other countries in Europe …

STORY 2

Training Frontline Health Care Workers

As the COVID-19 pandemic arrived in Sierra Leone, ICAP’s experience in health care worker training, mentoring and supportive supervision …

STORY 3

Researching Biomedical Responses to COVID-19

Recognizing the urgency of developing prevention and treatment responses to COVID-19, ICAP rapidly mobilized …

STORY 4

Saving Lives with Music

Building on the experience of developing prior community mobilization efforts for the HIV response, ICAP appreciated the potential power of …

STORY 5

Sustaining Methadone Treatment During Lockdown

While the advent of the COVID-19 pandemic in early 2020 dominated the attention of global public health, the challenge of treating drug addiction and HIV – often co-occurring –  was only complicated by fear of COVID-19 and the necessary restrictions imposed by governments to prevent transmission.

STORY 6

Harnessing Tech to Advance HIV Recency Testing

As hope for the end of the HIV pandemic is coming into sight in many countries, public health systems in high-burden countries now have a laser focus on …

STORY 7

Surveying the HIV Epidemic Undaunted

Since 2014, the Population-based HIV Impact Assessment (PHIA) Project has been guiding the global HIV response by conducting national  …

STORY 8

Responding to Malaria in Remote Regions

More than two-thirds of Ethiopia’s population lives in malaria high-risk areas and more than 1.5 million cases are reported annually …

STORY 9

Confronting the Threat of Antimicrobial Resistance

While the rapid spread of COVID-19 continues to dominate headlines around the world, another health crisis looms large: the global threat of antimicrobial …

STORY 10

Connecting Key Populations to Care

For people who suffer from stigma and fear, including sex workers, men who have sex with men, people who inject drugs and victims of gender-based …

X