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By Karin Hatzold, Associate Director & Project Director, HIV, PSI
COVID-19 has overwhelmed health systems in many countries and lockdowns have disrupted access to health care services — further jeopardizing public health goals including achieving universal health coverage (UHC). Supply chains for health care commodities, diagnostics and drugs and critical resources have been diverted from HIV programs to fight the new pandemic.
The COVID-19 pandemic has disproportionately impacted the people most affected by existing diseases: the poor, the marginalized, those without access to health care. People living with HIV experience more severe outcomes and have higher comorbidities from COVID-19 than people not living with HIV. Yet, in mid-2021, most people living with HIV did not have access to COVID-19 vaccines.
In Africa, the impact of the COVID-19 pandemic on HIV services is of particular concern and has stalled progress towards UHC.
HIV remains one of the leading causes of mortality with more than 460,000 HIV related deaths across sub-Saharan Africa in 2021 despite improvement in HIV prevention, testing and treatment. Some countries experienced nearly 50% declines in HIV testing and 35-40% declines in antiviral therapy (ART) in 2020 during COVID-19 lockdowns compared to pre-pandemic 2019 levels.
The appearance of new COVID-19 variants, such as Omicron, and the horrific increases in cases in the fourth wave observed in many countries suggest that the pandemic is likely to continue over the next few years. Countries need to be prepared to prevent the negative impact on HIV services, especially HIV testing, ART, and continuation of HIV prevention service delivery.
HIV self-testing (HIVST) is an effective self-care tool, allowing individuals to seek out an HIV test based on their own assessment of risk and need.
Offering a discreet and convenient way to test, HIVST has rapidly become a standard approach to HIV diagnosis, particularly in many high burden settings. In order to reach people from priority population groups globally—during and beyond the pandemic—HIVST provided a foundation from which the potential of other self-testing and self-care approaches can now be more readily realized.
Implementation of HIVST can be easily adapted to the COVID-19 context. The Unitaid-funded STAR Project has shown that HIVST can replace facility-based HIV testing to decongest health care facilities. HIVST distribution at community level can be adapted to increase access, including at market access points, COVID-19 screening and vaccination sites, mail-order systems, and pharmacies. In high HIV burden settings, distribution of HIVST kits from pregnant women to their male partners or home-based testing together with the partner using HIVST kits has been highly effective to reach men who have never been tested for HIV, including undiagnosed men living with HIV.
Routine HIV testing is a core component of patient management in PrEP programs and recommended quarterly for all individuals taking PrEP. However, frequent HIV testing can be burdensome to some PrEP patients, particularly for those who face logistical barriers to accessing healthcare, which are further exacerbated during Covid-19 restrictions.
Following the WHO and PEPFAR recommendations for HIVST use during Covid-19, Brazil, Vietnam and South Africa started implementing HIVST/PrEP services. Telemedicine and HIV self-testing were adopted by Brazilian Public Health services to minimize disruptions in PrEP access and delivery during the COVID-19 pandemic showing high level of acceptability among PrEP/HIVST users and providers of PrEP telemedicine. HIVST/PrEP home delivery demonstrated increased access to men who have sex with men, transgender and non-binary individuals facing stigma, adherence concerns, and medical distrust. Similarly, in Vietnam HIV self-test kits were couriered, posted, or otherwise delivered to those seeking testing services and people who tested negative with the self-test could receive PrEP in the same way that they had received the HIVST kit, through online ordering and home delivery.
New WHO guidance on the use of HIVST to be considered for people taking post-exposure prophylaxis and PREP could increase access continuation, retention and adherence to PrEP, providing opportunities for users to manage their own health care needs. Simplifying PrEP and adapting services to the real world, including HIVST/PrEP online and virtual interventions, will provide more options and flexibility for taking PrEP based on clients needs and preferences, greater convenience and reduced opportunity costs and is leading to greater user engagement, empowerment and ownership, which should be considered as countries work to expand UHC.
While the number of countries with HIVST policies and implementation in the public and private sector has increased exponentially since 2016 when WHO normative guidance has been launched. But there is still a substantial gap in the number of registered WHO prequalified HIVST kits as well as scaled distribution at the country-level.
Considering the effect of COVID-19 on individuals, communities and health systems, countries should urgently overcome policy and regulatory barriers to HIVST implementation and enable widespread access to HIVST as part of countries’ approach to achieving UHC. Making HIV self-testing available as a part of the health system during and after the COVID-19 is an essential measure to ensure that those at risk of HIV, including those that have never tested for HIV before, have continued access to COVID-19 safe HIV testing, antiretroviral therapy and PrEP — and is part of an overall health system.
Join STAR Initiative at ICASA 2021 this week to learn more about how HIV self-testing (HIVST) is playing a critical tool to maintain essential testing services during COVID-19 disruptions.
With overarching commitments to flexibility in our work, and greater wellbeing for our employees, we want to ensure PSI is positioned for success with a global and holistic view of talent. Under our new “work from (almost) anywhere,” or “WFAA” philosophy, we are making the necessary investments to be an employer of record in more than half of U.S. states, and consider the U.S. as one single labor market for salary purposes. Globally, we recognize the need to compete for talent everywhere; we maintain a talent center in Nairobi and a mini-hub in Abidjan. PSI also already works with our Dutch-based European partner, PSI Europe, and we’re creating a virtual talent center in the UK.
PSI is firmly committed to the meaningful engagement of young people in our work. As signatories of the Global Consensus Statement on Meaningful Adolescent & Youth Engagement, PSI affirms that young people have a fundamental right to actively and meaningfully engage in all matters that affect their lives. PSI’s commitments aim to serve and partner with diverse young people from 10-24 years, and we have prioritized ethics and integrity in our approach. Read more about our commitments to the three core principles of respect, justice and Do No Harm in the Commitment to Ethics in Youth-Powered Design. And read more about how we are bringing our words to action in our ICPD+25 commitment, Elevating Youth Voices, Building Youth Skills for Health Design.
PSI works to ensure that its operations and supply chains are free from slavery and human trafficking. Read more about this commitment in our policy statement, endorsed by the PSI Board of Directors.
Since 2017, PSI has been a signatory to the United Nations Global Compact, a commitment to align strategies and operations with universal principles of human rights, labor, environment and anti-corruption. Read about PSI’s commitment to the UN Global Compact here.
The health of PSI’s consumers is inextricably linked to the health of our planet. That’s why we’ve joined the Climate Accountability in Development as part of our commitment to reducing our greenhouse gas emissions by 30 percent by 2030. Read about our commitment to environmental sustainability.
PSI does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, protected veteran status or any other classification protected by applicable federal, state or local law. Read our full affirmative action and equal employment opportunity policy here.
PSI is committed to establishing and maintaining a work environment that fosters harmonious, productive working relationships and encourages mutual respect among team members. Read our policy against discrimination and harassment here.
PSI is committed to serving all health consumers with respect, and strives for the highest standards of ethical behavior. PSI is dedicated to complying with the letter and spirit of all laws, regulations and contractual obligations to which it is subject, and to ensuring that all funds with which it is entrusted are used to achieve maximum impact on its programs. PSI provides exceptionally strong financial, operational and program management systems to ensure rigorous internal controls are in place to prevent and detect fraud, waste and abuse and ensure compliance with the highest standards. Essential to this commitment is protecting the safety and well-being of our program consumers, including the most vulnerable, such as women and children. PSI maintains zero tolerance for child abuse, sexual abuse, or exploitative acts or threats by our employees, consultants, volunteers or anyone associated with the delivery of our programs and services, and takes seriously all complaints of misconduct brought to our attention.
PSI affirms its commitment to diversity and believes that when people feel respected and included they can be more honest, collaborative and successful. We believe that everyone deserves respect and equal treatment regardless of gender, race, ethnicity, age, disability, sexual orientation, gender identity, cultural background or religious beliefs. Read our commitment to diversity and inclusion here. Plus, we’ve signed the CREED Pledge for Racial and Ethnic Equity. Learn more.
PSI affirms gender equality is a universal human right and the achievement of it is essential to PSI’s mission. Read about our commitment to gender equality here.