{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:44:06Z","timestamp":1791225846989,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The potential disruption in antiretroviral therapy (ART) services in Africa at the start of the COVID\u201019 pandemic raised concern for increased morbidity and mortality among people living with HIV (PLHIV). We describe HIV treatment trends before and during the pandemic and interventions implemented to mitigate COVID\u201019 impact among countries supported by the US Centers for Disease Control and Prevention (CDC) through the President's Emergency Plan for AIDS Relief (PEPFAR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed quantitative and qualitative data reported by 10,387 PEPFAR\u2010CDC\u2010supported ART sites in 19 African countries between October 2019 and March 2021. Trends in PLHIV on ART, new ART initiations and treatment interruptions were assessed. Viral load coverage (testing of eligible PLHIV) and viral suppression were calculated at select time points. Qualitative data were analysed to summarize facility\u2010 and community\u2010based interventions implemented to mitigate COVID\u201019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The total number of PLHIV on ART increased quarterly from October 2019 (<jats:italic>n<\/jats:italic>= 7,540,592) to March 2021 (<jats:italic>n<\/jats:italic>= 8,513,572). The adult population (\u226515 years) on ART increased by 14.0% (7,005,959\u20137,983,793), while the paediatric population (&lt;15 years) on ART declined by 2.6% (333,178\u2013324,441). However, the number of new ART initiations dropped between March 2020 and June 2020 by 23.4% for adults and 26.1% for children, with more rapid recovery in adults than children from September 2020 onwards. Viral load coverage increased slightly from April 2020 to March 2021 (75\u201378%) and viral load suppression increased from October 2019 to March 2021 (91\u201394%) among adults and children combined. The most reported interventions included multi\u2010month dispensing (MMD) of ART, community service delivery expansion, and technology and virtual platforms use for client engagement and site\u2010level monitoring. MMD of \u22653 months increased from 52% in October 2019 to 78% of PLHIV \u2265 age 15 on ART in March 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>With an overall increase in the number of people on ART, HIV programmes proved to be resilient, mitigating the impact of COVID\u201019. However, the decline in the number of children on ART warrants urgent investigation and interventions to prevent further losses experienced during the COVID\u201019 pandemic and future public health emergencies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26033","type":"journal-article","created":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T13:11:41Z","timestamp":1669295501000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Protecting the gains: analysis of HIV treatment and service delivery programme data and interventions implemented in 19 African countries during COVID\u201019"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9408-9904","authenticated-orcid":false,"given":"Pamela J.","family":"Bachanas","sequence":"first","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen M.","family":"Chun","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Aberle\u2010Grasse","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KaeAnne","family":"Parris","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle Williams","family":"Sherlock","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clement","family":"Zeh","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne K.","family":"Makwepa","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max L.","family":"Kapanda","sequence":"additional","affiliation":[{"name":"National ART Program Ministry of Health and Wellness Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily Kainne","family":"Dokubo","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Yaounde Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Bonono","sequence":"additional","affiliation":[{"name":"National AIDS Control Committee Ministry of Public Health Yaounde Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirish","family":"Balachandra","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Abidjan Cote d\u2019 Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eboi","family":"Ehui","sequence":"additional","affiliation":[{"name":"National AIDS Control Program Ministry of Health and Public Hygiene Abidjan Cote d\u2019 Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Fonjungo","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Kinshasa Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aim\u00e9 M.","family":"Nkoso","sequence":"additional","affiliation":[{"name":"Ministry of Health Kinshasa Democratic Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikhathele","family":"Mazibuko","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Mbabane Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Velephi N.","family":"Okello","sequence":"additional","affiliation":[{"name":"Health Services \u2013 Clinical Ministry of Health Mbabane Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fana","family":"Tefera","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirtie","family":"Getachew","sequence":"additional","affiliation":[{"name":"Disease Prevention and Control Directorate Ministry of Health Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Katiku","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Mulwa","sequence":"additional","affiliation":[{"name":"Preventive and Promotive Health Ministry of Health Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred M.","family":"Asiimwe","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Maseru Lesotho"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapiwa F.","family":"Tarumbiswa","sequence":"additional","affiliation":[{"name":"Ministry of Health Maseru Lesotho"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew F.","family":"Auld","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"Ministry of Health Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alzira P.","family":"Dos Santos De Louvado","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irenio","family":"Gaspar","sequence":"additional","affiliation":[{"name":"HIV Program Ministry of Health Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven Y.","family":"Hong","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laimi","family":"Ashipala","sequence":"additional","affiliation":[{"name":"HIV\/STI Sub\u2010Division, Directorate Special Programmes Ministry of Health and Social Services Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Obanubi","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akudo","family":"Ikpeazu","sequence":"additional","affiliation":[{"name":"National AIDS\/STI Control Programme Federal Ministry of Health Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Canisious","family":"Musoni","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Yoboka","sequence":"additional","affiliation":[{"name":"Ministry of Health Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simangele","family":"Mthethwa","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zukiswa","family":"Pinini","sequence":"additional","affiliation":[{"name":"HIV, AIDS &amp; STIs Cluster National Department of Health Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhir","family":"Bunga","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Juba South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Rumunu","sequence":"additional","affiliation":[{"name":"Preventive Health Services Ministry of Health Juba Republic South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Magesa","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Mutayoba","sequence":"additional","affiliation":[{"name":"Ministry of Health Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa J.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordelia","family":"Katureebe","sequence":"additional","affiliation":[{"name":"Ministry of Health Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5023-5754","authenticated-orcid":false,"given":"Simon","family":"Agolory","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd B.","family":"Mulenga","sequence":"additional","affiliation":[{"name":"Ministry of Health Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ponesai","family":"Nyika","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"Mugurungi","sequence":"additional","affiliation":[{"name":"Ministry of Health Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tedd","family":"Ellerbrock","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiren","family":"Mitruka","sequence":"additional","affiliation":[{"name":"Division of Global HIV\/AIDS and TB Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"WHO COVID19_Cases (arcgis.com)","author":"World Health Organization","year":"2021"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2008193"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41182-020-00206-x"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1605"},{"issue":"4","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/25787489.2021.1975608","article-title":"HIV and COVID\u201019: review of clinical course and outcomes","volume":"22","author":"Barbera LK","year":"2021","journal-title":"HIV Res Clin Pract"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.26533"},{"key":"e_1_2_12_8_1","volume-title":"Global HIV & AIDS statistics \u2014 fact sheet","author":"UNAIDS","year":"2021"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30211-3"},{"key":"e_1_2_12_10_1","volume-title":"Fast track: fast\u2010track strategy to end the AIDS epidemic by 2030","author":"UNAIDS","year":"2014"},{"key":"e_1_2_12_11_1","unstructured":"The President's Emergency Plan for AIDS Relief (PEPFAR). About us \u2013 PEPFAR.Washington DC:United States Department of State;2021."},{"issue":"4","key":"e_1_2_12_12_1","first-page":"41","article-title":"Multi\u2010month prescriptions, fast\u2010track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals","volume":"20","author":"Prust ML","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-019-00454-5"},{"key":"e_1_2_12_14_1","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach","author":"World Health Organization","year":"2016"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0166444"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208814"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25640"},{"key":"e_1_2_12_18_1","first-page":"e628","article-title":"Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a cluster randomised, non\u2010blinded, non\u2010inferiority trial","volume":"9","author":"Hoffman RM","year":"2021","journal-title":"Lancet"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25207"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002439"},{"key":"e_1_2_12_21_1","volume-title":"Disruption in HIV, hepatitis and STI services due to COVID\u201019","author":"World Health Organization","year":"2020"},{"key":"e_1_2_12_22_1","unstructured":"The Global Fund. The impact of COVID\u201019 on HIV TB and malaria services and systems for health: a snapshot from 502 health facilities across Africa and Asia.Geneva:2021."},{"key":"e_1_2_12_23_1","unstructured":"U.S. State Department.The President's Emergency Plan for AIDS Relief (PEPFAR).Washington DC. Accessed on September 8 2021. Available from:07.01.2020-PEPFAR-Technical-Guidance-During-COVID.pdf (state.gov)."},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25503"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25587"},{"key":"e_1_2_12_26_1","unstructured":"DATIM (Data for Accountability Transparency and Impact).DATIM (zendesk.com). PEPFAR accessed October 13 2021."},{"key":"e_1_2_12_27_1","unstructured":"US Department of State. Monitoring Evaluation and Reporting Indicator Reference Guide. MER 2.0 (Version 2.5).FY21 MER 2.5 Indicator Reference Guide (state.gov). September2020."},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25704"},{"issue":"6","key":"e_1_2_12_29_1","article-title":"The impact of COVID\u201019 on multi\u2010month dispensing (MMD) policies on antiretroviral therapy (ART) and MMD uptake in 21 PEPFAR\u2010supported countries: a multi\u2010country analysis","volume":"24","author":"Bailey L","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-020-00513-z"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2020.37.255.23787"},{"key":"e_1_2_12_32_1","unstructured":"DrammehB DeeA LasryA MedleyA AholouT YeeR DaleH et\u00a0al.Changes in HIV testing services after COVID\u201019 in 11 sub\u2010Saharan Africa countries.Conference on Retroviruses and Opportunistic Infections (CROI) Virtual 2021 Oral presentation of abstract 143."},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25622"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25482"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-019-00470-5"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2055-6640(20)30344-7"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12843"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab428"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26033","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.26033","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T13:17:36Z","timestamp":1728479856000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":37,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1002\/jia2.26033"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26033","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11]]},"assertion":[{"value":"2022-03-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26033"}}