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Namibia was close to controlling its HIV epidemic when COVID-19 arrived: 95 percent of people with HIV knew their status, 95 percent of them were on antiretroviral therapy (ART), and 92 percent of those had suppressed the virus. The risk was that the pandemic would undo it — so the Ministry of Health and Social Services moved quickly to keep people on treatment while keeping them out of crowded clinics.
The emergency
Namibia, an upper-middle-income country of about 2.5 million people, identified its first two COVID-19 cases on March 13, 2020, in recently arrived travelers. On March 17 the president declared a state of emergency: borders closed, regional travel was restricted, schools shut, and gatherings were suspended. By October 19, Namibia had reported 12,326 laboratory-confirmed cases and 131 deaths. CDC's Namibia office, through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which has supported Namibia since 2004, helped coordinate the HIV program with the COVID-19 response.
Three changes
| Change | What it involved |
|---|---|
| Clinic readiness | screening arriving patients for COVID-19 symptoms, isolating and testing those with symptoms; fast-track refills without entering the building or quick small-group consultations for others; expedited service for people 50 and older or with underlying conditions; protective equipment for staff |
| Multimonth dispensing | four-month supplies of ART; the National Central Medical Store sent 4–6 months of stock for 166,237 of 171,830 patients (97%) to facilities in every region, and emergency procurement secured a 12-month national supply |
| Community dispensing | new community ART points, primary care outreach points, community adherence groups (fewer than 10 at a time), mobile vans, home delivery by community health workers, and a national ART hotline |
Outreach points on the borders were especially important for Angolan patients who crossed for refills despite the border closures.
Coordinating at a distance
Regional clinical mentors — experienced ART physicians in each of Namibia's 14 regions — carried out the changes. Guidance went out through Project ECHO, a virtual mentoring platform Namibia had adopted in 2015, among the first African countries to do so. From March 17 to April 21, seven sessions reached 760 sites and 2,068 health care providers, despite the travel restrictions.
A model
Early public health measures bought time to prepare for a possible surge, and the adapted program kept essential HIV services running safely. The report suggests the approach could work wherever COVID-19 threatens HIV treatment, given governments and providers willing to use new technology and new strategies.
Sources
Based on "Rapid Adaptation of HIV Treatment Programs in Response to COVID-19 — Namibia, 2020," by Steven Y. Hong and colleagues (CDC and Namibia's Ministry of Health and Social Services), Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licens: CC0 1.0 (allmän egendom) · Bearbetat efter www.cdc.gov
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