Keeping HIV services open during a pandemic

When the first COVID-19 cases were confirmed in Tanzania in March 2020, EpiC was barely a quarter old. Group SBCC sessions, drop-in centre crowding, and facility-based testing — the staples of the original work plan — became suddenly unsafe. The team had a choice: pause and protect the gains, or redesign and protect the people.

Within three weeks ASUTA, FHI360 and the CHMTs agreed a revised modality. Group sessions were capped at ten participants in ventilated outdoor spaces, mandatory hand-washing stations were procured for every drop-in centre, and a tiered protective equipment supply chain was set up for peers.

The single largest pivot was the rapid scale-up of HIV Self-Testing (HIVST). With Ministry of Health approval secured, peers distributed 1,820 OraQuick oral fluid kits in the quarter, with structured pre- and post-test counselling delivered by phone.

Reactive results triggered an immediate confirmatory test through a discreet mobile referral. Of 47 reactive HIVST results, 44 (94 percent) accepted confirmatory testing, and all 41 confirmed positives were linked to antiretroviral therapy within ten days — a stronger linkage rate than the pre-COVID facility pathway.

Peers began running structured WhatsApp groups for clients on PrEP and ART, sending appointment reminders and short SBCC videos. Sixty-eight percent of follow-up contacts in May and June 2020 were delivered remotely, and adherence to scheduled refill dates held above 88 percent.

The lesson is not that digital replaces presence. The lesson is that when in-person contact is constrained, structured remote contact can carry the relationship long enough for the in-person work to resume.