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AbstractIntroductionNon‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here.DiscussionLaunched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre‐exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person‐centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility‐based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community‐based pickup points, facility "fast lanes" and adherence clubs with public sector health facilities and private sector medication collection units. There are no out‐of‐pocket payments for medications or testing commodities. Wait‐times for medication refills are lower at CCMDD sites than facility‐based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications.ConclusionsEswatini and South Africa demonstrate person‐centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends.

AbstractIntroductionThe COVID‐19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID‐19 preparedness and response plans were rapidly instituted across sub‐Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID‐19 pandemic would have in under‐resourced settings with high burdens of PLHIV. The potential negative impact of COVID‐19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID‐19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID‐19‐related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID‐19. This commentary reviews PEPFAR's COVID‐19 technical guidance and provides country‐specific examples of programme adaptions in sub‐Saharan Africa.DiscussionThe COVID‐19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over‐burdened health systems. Although there is currently limited understanding of how COVID‐19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID‐19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in‐person home and facility visits and other direct contact when COVID‐19 control measures are in effect. PEPFAR‐supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID‐19 in sub‐Saharan Africa.ConclusionsAs community transmission of COVID‐19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data‐driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID‐19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.

AbstractIntroductionThe Uganda Ministry of Health recommends facility‐ and community‐based differentiated antiretroviral therapy (DART) models to support person‐centred care for eligible clients receiving antiretroviral therapy (ART). Healthcare workers assess client eligibility for one of six DART models upon initial enrolment; however, client circumstances evolve, and their preferences are not routinely adjusted. We developed a tool to understand the proportion of clients accessing preferred DART models and compared the outcomes of clients accessing preferred DART models to the outcomes of clients not receiving preferred DART models.MethodsWe conducted a cross‐sectional study. A sample of 6376 clients was selected from 113 referrals, general hospitals and health centres purposely selected from 74 districts. Clients receiving ART accessing care from the sampled sites were eligible for inclusion. Healthcare workers interviewed clients (caretakers of clients under 18), over a 2‐week period between January and February 2022 using a client preference tool to elicit whether clients were receiving DART services through their preferred model. Treatment outcomes of viral load test, viral load suppression and missed appointment date were extracted from clients' medical files before or immediately after the interview and de‐identified. The descriptive analysis determined the interaction between client preferences and predefined treatment outcomes by comparing outcomes of clients whose care aligned with their preferences to outcomes of clients whose care misaligned with their preferences.ResultsOf 25% (1573/6376) of clients not accessing their preferred DART model, 56% were on facility‐based individual management and 35% preferred fast‐track drug refills model. Viral load coverage was 87% for clients accessing preferred DART models compared to 68% among clients not accessing their preferred model. Viral load suppression was higher among clients who accessed the preferred DART model (85%) compared to (68%) clients who did not access their preferred DART model. Missed appointments were lower at 29% for clients who accessed preferred DART models compared to 40% among clients not enrolled in the DART model of their choice.ConclusionsClients who accessed their preferred DART model have better clinical outcomes. Preferences should be integrated throughout health systems, improvement interventions, policies and research efforts to ensure client‐centred care and client autonomy.