Zambian Patients and Health Workers Benefit from Multi-Month HIV Prescriptions During COVID-19
Reduced visits ease the burden on facilities and keep clients safe
In Kitwe, the commercial hub of Zambia’s Copperbelt Province, Jacqueline Lengwe is in charge of the Chimwemwe Urban Health Center. One of the largest in Kitwe, the facility serves a population of over 50,000 people and provides more than 5,000 clients with life-saving antiretroviral therapy (ART) for HIV.
A trained nurse, Jacqueline oversees clinical and support staff, delegates nursing assignments, and monitors and orders supplies and medicines, including ART. And, she is fully aware of the importance of strict adherence to daily ART to keep HIV viral loads suppressed, as it helps protect clients’ own health and limits HIV transmission.
To make it easier for clients to get their medications and stay on treatment, Jacqueline’s clinic offers multi-month dispensing (MMD) of ART to stable clients. Medically stable clients can receive six months of ART, thus eliminating the need for monthly clinic visits. This benefit is especially valuable during the COVID-19 pandemic, when maintaining social distance and avoiding crowded places are key to prevent infection. Research has shown that clients enrolled in MMD have significantly greater treatment adherence and retention than clients following a monthly drug regimen.
“This has made our work easier because when you supply clients with drugs for a period of six months, it means less people are coming through to the facility,” said Jacqueline. “It really helped us to reduce the client flow.”
The Chimwemwe Health Center is one of over 260 public health facilities in Zambia that pivoted to six months of medications (known as 6MMD) as part of the USAID Supporting an AIDS-Free Era (SAFE) project, which works with the Zambia Ministry of Health to reduce HIV mortality, morbidity, and transmission in Zambia’s Central, Copperbelt, and North-Western provinces. The facilities also instituted weekend and after-hours care, and home delivery, all while adhering to COVID-19 safety guidelines.
Jacqueline and the clinic staff are seeing the benefits. Kunda Bwalya, a pharmacy technician at Chimwemwe, says she can now dedicate more time to all patients.
“The clients would have questions that they wanted to ask me, but when they looked at the long queue of other clients waiting to be attended, they would not ask,” says Bwalya. “Now I have quality time with them, they’re able to ask their questions, and I can provide the best possible answers.”
In 2020, USAID SAFE increased the proportion of its eligible clients on 6MMD from 20 percent in January to 60 percent in June, coming to serve more than 175,000 clients. The project was also successful in another important measure: the percentage of clients who continue on treatment across subsequent reporting periods, known as proxy retention. USAID SAFE closed the gap in proxy retention of clients on ART from 98 percent in April to 100 percent in June. They accomplished this through intensive efforts of client navigators to remind clients of appointments and to sign up for 6MMD.
Jacqueline says the 6MMD roll-out has also helped her do her job safely and more efficiently. “We do not see our clients on ART daily as we did before, so it no longer takes such a long time to clear them. Now, it’s something that we can manage.”
The benefits of 6MMD extend beyond health workers. 6MMD reduces stress on pharmacy services and the health supply chain, and eases the burden of monthly facility visits for clients. “When we told clients that they were now going to be supplied with medication for six months, they were happy,” said Jacqueline.
Through the President’s Emergency Plan for AIDS Relief and USAID support, SAFE works through public and private health facilities to provide access to and utilization of high quality HIV prevention and treatment services. Representing a U.S. Government investment of $142 million over five years, the goal of USAID SAFE is to reduce HIV mortality, morbidity, and transmission, while improving nutrition outcomes and family planning integration.
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John Snow Inc. is a public health management consulting and research organization dedicated to improving the health of individuals and communities throughout the world. Follow @JSIhealth for more.
