Multimonth Dispensing of Antiretroviral Therapy Protects the Most Vulnerable From 2 Pandemics at Once

MULTIMONTH ART DISPENSING MITIGATES RISK OF HIV AND COVID-19

Multimonth dispensing (MMD) is an aspect of differentiated service delivery that provides patients with either 3 or 6 months of medication and eliminates the need for monthly clinic and/or community facility visits. From the patient’s perspective, MMD has already been shown to reduce the cost of travel, reduce patient burden, and limit the hours of work or school lost.^5,6 Importantly, MMD improves adherence and viral suppression.^5,7 In the context of the COVID-19 pandemic, this viral suppression strengthens the immune system and likely mitigates the risk of severe COVID-19.⁸ MMD, essential to caring for PLHIV, is arguably even more critical during the COVID-19 pandemic.

Currently, only 21 countries have formal 6-month dispensing policies. Two countries allow clinicians to provide 6-month supply when they deem appropriate, and 8 countries have a 3-month dispensing policy in place. South Africa, the country with the largest number of PLHIV, only has a 2-month dispensing policy in place.

To mitigate the damage caused by SARS-CoV-2 while protecting the health of PLHIV, we encourage countries to rapidly implement 3-month if not 6-month dispensing. As a key strategy to safeguard patients and health care workers providing HIV services, MMD also reduces clinic visits, improves viral suppression, encourages social distancing, and potentially saves patients from the dual threat of SARS-CoV-2 and HIV. As SARS-CoV-2 spreads, patient caseloads are likely to increase across low- and middle-income countries where HIV burden is high and millions of people are stable on effective treatment. Implementing MMD quickly will protect the time and health of existing health care professionals and ready our health systems for imminent threats as well as any that may follow.