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Global Fund signs a record-breaking $8.54 billion in grants to fight HIV, TB and Malaria

GENEVA – In 2020, the Global Fund signed 157 grants for a total of US$8.54 billion for lifesaving HIV, Tuberculosis (TB) and malaria programs and to strengthen systems for health. This is the highest amount of grants ever signed in a single year by the Global Fund. The grants will begin implementation this month.

“This is an exceptional achievement that will help more than 100 countries continue the critical fight against HIV, TB and malaria – epidemics that kill more than 2.3 million people every year,” said Peter Sands, Executive Director of the Global Fund. “As the COVID-19 pandemic overwhelms health systems around the world, it is now more important than ever that we ensure countries have the resources they need to fight HIV, TB and malaria and to strengthen the systems for health needed to respond to all four diseases.”

The Global Fund has a total of US$12.71 billion available in funding allocations for the three-year funding cycle that runs from 2020-2022. Of these funds, the Global Fund had planned for US$8.9 billion in grants to be approved in 2020, with the remaining funds scheduled for later start dates. However, the Secretariat accelerated its grant-making efforts and exceeded the original target, approving US$9.2 billion of funding in 2020. As of 31 December 2020, US$8.54 of the approved grants had been signed and begin implementation this month; two countries were still in the process of signing the remaining finalized grants worth US$660 million.

“Even in the midst of a new global pandemic, during an extraordinarily challenging year, the Global Fund partnership has supported countries to develop grants more quickly and effectively than ever before,” said Donald Kaberuka, Global Fund Board Chair. “A record-breaking 67% of grants for the 2020-2022 funding cycle have now been signed, compared to 50% of grants signed at the same time in the last funding cycle, representing a remarkable increase in performance.”

In comparison, at the same time in the 2017-2019 funding cycle, the Global Fund had signed US$5.2 billion in grants out of a US$10.3 billion funding allocation.

Over the past year, the Global Fund has supported implementing partners and Country Coordinating Mechanisms (the committee of local community, government and health experts that develop and guide Global Fund-supported programs in a country) to develop detailed funding requests for programs to respond to the epidemics at the country level. As part of the Global Fund’s grant-making process, all funding requests are reviewed by an independent Technical Review Panel and then by the Grant Approvals Committee for quality and comprehensiveness before going to the Global Fund Board for final approval. Once the Global Fund and the implementing partners sign the grant, implementation of programs can begin.

The Global Fund is extremely appreciative of the continued support of donors for its core funding, as pledges made at the record-breaking Replenishment Conference in Lyon in October 2019 are converted into cash contributions. Sustaining funding levels for the fight against HIV, TB and malaria is vital at a moment when disruptions related to the COVID-19 pandemic threaten to reverse many years of progress against the three diseases.

On top of the new grants awarded to fight HIV, TB and malaria, the Global Fund has approved US$980 million in additional funding to 106 low- and middle-income countries and 14 multicountry programs to respond to COVID-19 in 2020. The Global Fund has estimated that it needs a further US$5 billion on top of its core funding to support countries in responding to the pandemic by reinforcing national COVID-19 responses; mitigating the impact of COVID-19 on lifesaving HIV, TB and malaria programs; and making urgent improvements to health and community systems.

Attaining UNAIDS’ proposed societal and legal barrier targets could stop 440 000 AIDS-related deaths 

UNAIDS has called on countries to make far greater investments in global pandemic responses and adopt a new set of bold, ambitious but achievable HIV targets for 2025.

An analysis was performed focused on available studies that have quantitatively measured the negative impact of stigma and discrimination and the criminalization of sex work, drug use and same-sex sexual relationships on HIV prevention, testing and treatment efforts.

The analysis suggests that failure to make any progress on HIV-related stigma and discrimination would undermine efforts to reach the HIV testing, treatment and viral suppression targets, resulting in an additional 440 000 AIDS-related deaths between 2020 and 2030, and that failure to make any progress across all societal enablers would undermine efforts to reach HIV prevention targets, resulting in 2.6 million additional new HIV infections over the same period.

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Guyana to end mother-to-child transmission of HIV, further reduce new infections by 2025

On Tuesday, Guyana recommitted itself to the Global AIDS Strategy, which hopes to end AIDS by 2030, launching a new National HIV Strategic Plan 2021- 2025.

The new plan puts Guyana on track with global momentum but sets achievable benchmarks for the country and strengthens its national HIV and AIDS response.

By 2025, Guyana hopes to reduce new HIV infections among key populations and other vulnerable groups by 95 percent.

Also, by 2025 all babies are expected to be born free of HIV and other Sexually Transmitted Infections (STIs), ending mother-to-child transmission.

Guyana wants to also reduce AIDS-related deaths by 95 percent within the next five years.

In the past seven years, the national fight against HIV and AIDS was guided by the National HIV Vision document, which came to an end last year.

During the virtual launch of the innovative and progressive plan to achieve epidemic control on Tuesday, Guyana also boasted being the first Caribbean country to achieve the First 90 of the UNAIDS 90-90-90 goals.

This means that at the end of 2020, 90% of all People Living with HIV in Guyana knew their status.

Guyana falls short on the other two indicators where 72 percent of Guyanese with a diagnosed HIV infection are on antiretroviral therapy and 75 percent of those receiving antiretroviral therapy being virally suppressed.

Minister of Health Dr Frank Anthony acknowledged these shortcomings with the ambitious treatment target of 90 percent needed to be achieved.

Dr Anthony said while Guyana aspires to end AIDS by 2030, there are many other targets along the way.

He said Guyana had set its own target of 95 percent on several key indicators by 2025.

“There is a lot of underlying work that needs to be done to ensure the targets are met. While we fix exiting problems, we have to look to improve other targets,” he said.

The Minister said the political will exists to introduce a more comprehensive program with PrEP (Pre-exposure prophylaxis) – a medicine people at risk for HIV take to prevent getting HIV.

Guyana had only been making this medication available to couples where one partner has tested positive for HIV.  Dr Anthony now says that the country intends to make it available for all citizens who are considered at risk.

The Minister said policies would be put in place to push self-testing among the population.

The new National HIV Strategic Plan was developed, revised and finalized through a process that included all stakeholders over the past year. It commenced in January 2020.

Acknowledging that there has been little change in the epidemic over the last five years with a small decline in 2018, Consultant Dereck Springer said there is now a strong political commitment and enabling environment to accelerate the national AIDS response.

He said that while there have been achievements, the response is still faced with numerous challenges that the new strategy addresses.

Springer said there continues to be dysfunctional coordination, high levels of stigma and discrimination and frequent stock-outs of medication.

These shortcomings, he says, will be addressed in the new plan.

Guyana to roll out HIV self-testing

(Via Demerara Waves, Georgetown, Guyana)  Health Minister Dr Frank Anthony on Tuesday announced that Guyanese would be allowed to self-test for HIV and that more at-risk persons would be given preventative drugs.

“Another area we want to look at is self-testing. This is relatively new, and it has been advocated around the world, and some countries have implemented it with relatively good success.  This is one of the measures we would like to put in place here in Guyana,” he said.

The Health Minister gave no specific time-frame by which self-testing would start in Guyana.

He made the announcement in an address to stakeholders at the launch of the HIV National Strategic Plan, which aims to bridge past achievements to end the disease by 2030. The Minister also disclosed that Guyana would be submitting a proposal to the Global Fund for support to fight the disease.

The Health Minister said a “more comprehensive” Pre-exposure Prophylaxis (PrEP) programme would be rolled out this year to build on the programme introduced last year to target couples, one of whom is HIV positive and the other is not. “We want to take that further so that anybody at risk can access PrEP.  Next year we will see a better roll-out of PrEP to ensure that this is at all of our clinics.  We will work with all stakeholders to ensure that this is also available with the services they provide,” he said.

Dr Anthony said Guyana has been suffering from a lag in two of the three areas identified globally by UNAIDS for bringing the disease under control.  This included knowing one’s status, receiving Antiretroviral Therapy and suppressing the disease by 2020.

He said statistics show that 94 percent of HIV positive persons in Guyana know their status, 73 percent of them have been tested and on treatment and the virus has been suppressed in 75 percent of them.  In that regard, he remarked that “we still have a lot of work to be done over the next five years”.

The Health Minister noted that weaknesses in the fight against HIV included stock-outs of reagents that have adversely affected testing, treatment and care. He hoped that this could be remedied through proper quantification by clinical staff and procurement. “While we fix existing problems, we also have to look forward to how we can improve and also use new methodologies to ensure that we can get to those targets by 2025,” he said.

Dr Anthony said “more effective” antiretroviral therapies were being rolled out along with co-morbidities such as Tuberculosis to fight other sexually transmitted diseases, including the Human-Papilloma Virus that causes Cervical Cancer.

Message from Dr Rosmond Adams, Director, PANCAP – November 2020

PANCAP joined the global community as we observed World AIDS Day on 1 December. Several activities were held across the Region to bring awareness to HIV, recognize the work that has been done and to strategize on how we can sustain the HIV response in the future.

We recognize the work at all levels, especially that of our global partners such as the Joint United Nations Programme on HIV and AIDS (UNAIDS), World Health Organisation (WHO), Pan American Health Organisation (PAHO), President’s Emergency Plan for AIDS Relief (PEPFAR) and others. Governments, National Programmes, Civil Society Organizations, People Living with HIV (PLHIV), Faith-Based Organizations, Communities and individuals have also played a central role in getting us to where we are today and have always been supportive to the PANCAP partnership.

Over the years, we have seen a record number of PLHIV receiving antiretroviral treatment.  We have also seen progress with “Undetectable = Untransmittable” (U=U), meaning that people who adhered to treatment and achieved an undetectable viral load cannot pass the virus on to others. New Infections and AIDS-related deaths in our Region have also decreased, and there have been bold actions to address issues such as stigma and discrimination around the disease.

Indeed, we have come a long way. When HIV was first recognized four decades ago, fear and death were the keywords that defined this disease as the world faced a new and unknown virus. Today, scientific advances, such as the development of antiretroviral drugs, have enabled people to access treatment to live long and healthy lives.

As we reflect on the 2020 theme for World AIDS Day, “Global Solidarity, Shared Responsibility”, it is essential to view it as a call to action for all of us to work together to end AIDS and to support our brothers and sisters living with HIV.

The road ahead is long, but once we work together, I am confident that we can end AIDS.

Global Fund Board Appoints Tracy Staines as Inspector General

4 December 2020 | GENEVA − The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria has appointed Tracy Staines, a distinguished auditor and seasoned executive, as Inspector General. Staines brings over 20 years of multi-sectoral experience in audit and risk management, including eight years at the Global Fund.

Promoted to Head of Audit in 2015, she has been serving as the Acting Inspector General since August 2020, after the departure of former Inspector General Mouhamadou Diagne. Staines is the first woman to hold the position of Inspector General, which reports directly to the Board.

“We are pleased to name Tracy to this critical role,” said Dr Donald Kaberuka, Global Fund Board Chair.

“Tracy’s long experience, robust knowledge of the Global Fund, commitment to the mission and a strong sense of professionalism will be central to leading the Office of the Inspector General to support the organization in the evolving global health environment,” said Lady Roslyn Morauta, Vice-Chair of the Board.

An independent, well-resourced and transparent Office of the Inspector General (OIG) is essential for the success of the Global Fund, Dr Kaberuka added. The Global Fund is committed to the highest standards of accountability in all matters, including the audits and investigations produced by the OIG. The Global Fund’s OIG is composed of 52 auditors, investigators, and other professional staff.

Staines replaces Mouhamadou Diagne, who announced in May 2020 that he would resign to take on the position of Vice-President of Integrity for the World Bank Group.

Staines’ appointment comes as a result of a robust global selection process that started in August 2020, led by a Board-appointed Inspector General Nomination Committee and supported by a search firm. A total of 145 applications were received by the application deadline of 11 September 2020, reflecting a diversity of gender, professional backgrounds and sector, and geographical locations. The Nomination Committee conducted a merit-based, competitive and apolitical process, informed by due diligence and background checks, and with due attention to diversity of candidate profiles, particularly diversity of gender, geographic background, and professional experience. Assessing candidates against Board-approved Terms of Reference, the Nomination Committee also paid particular attention to candidates’ track record with respect to Global Fund strategic issues including human rights and key populations affected by the three diseases.

During her tenure at the Global Fund, Staines has led an impactful audit unit, renowned for its solid, data-driven products. She has directed a comprehensive program of complex, high-profile reviews that have driven positive change, resulting in enhanced portfolio performance and significant improvements in accountability and risk management frameworks. She and her team have refocused the OIG’s annual assessment to maximize coverage of key risk areas including grant size, residual risk and disease burden. She leads on the delivery of a comprehensive annual opinion, setting out ambitious development areas, which have informed a series of enduring improvements at the Global Fund.

Staines has also led the development of an advisory capability within the OIG, evolving the unit into a value-adding strategic advisor. OIG advisory reports provide data-led and thoughtful analysis to senior management to drive improvements throughout the partnership. In addition, under her leadership, the OIG has cultivated strategic partnerships with Supreme Audit Institutions to build capacity and leverage local knowledge. She liaises closely with like-minded oversight functions and the United Nations Representatives of Internal Audit Services (UN-RIAS) community.

Prior to joining the Global Fund, Staines led audit and investigations teams at one of Europe’s largest banks and the UK Civil Service. She began her career with Deloitte, the world’s largest professional services firm, in London and Sydney. She is a Fellow of the Institute of Chartered Accountants in England and Wales, a Chartered Internal Auditor and a qualified member of the Chartered Institute for Securities and Investments.

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As COVID-19 reduces access to HIV testing services, AIDS response partners call for Caribbean countries to adopt HIV self-testing

KINGSTON, 1 December 2020—On the occasion of World AIDS Day, Caribbean AIDS response stakeholders are calling for countries in the region to adopt HIV self-testing. During the virtual launch of the “In Your Hands” Caribbean HIV self-testing campaign yesterday, partners advocated for self-testing policies to be developed and implemented as part of a comprehensive strategy to ensure that HIV diagnosis does not decline during the COVID-19 pandemic. The advocacy campaign is jointly endorsed by the Joint United Nations Programme on HIV/AIDS (UNAIDS), Pan American Health Organization (PAHO), Pan Caribbean Partnership against HIV and AIDS (PANCAP), President’s Emergency Plan for AIDS Relief (PEPFAR) and the Caribbean Med Labs Foundation (CMLF).

To achieve the Fast Track targets that would set countries on course to end AIDS by 2030, it is imperative that people living with HIV are diagnosed early, start treatment right away and achieve an undetectable viral load. People who are virally suppressed are not able to transmit the virus. Testing is the critical first pillar of this “treatment as prevention” strategy.

Even before COVID-19, the Caribbean was not on track to achieve the 90-90-90 testing and treatment targets due at the end of 2020. In 2019 77% of all people living with HIV in the Caribbean knew their status, 81% of diagnosed people were on treatment, and 80% of those on antiretroviral therapy were virally suppressed. A survey conducted by PANCAP and PAHO showed that during 2020, facility-and community- based HIV testing services reduced in two-thirds (69%) of countries due to COVID-19.

“This decline means that people with undiagnosed HIV are not getting life-saving antiretroviral treatment and, of course, continue to be unaware of their HIV status with the risk of potentially exposing others,” said Ms Sandra Jones,  PAHO’s Technical Advisor for HIV/STI, TB & Viral Hepatitis in the Caribbean.

“The COVID-19 pandemic… has presented the opportunity for us to explore new and innovative approaches that are result-oriented. We cannot sit and continue to debate how we can increase the number of people who know their HIV status without seizing the opportunity to explore and implement initiatives such as HIV self-testing,” PANCAP Director, Dr Rosmond Adams said.

According to UNAIDS Caribbean Sub-regional Office Director, Dr James Guwani, it is particularly important to increase testing uptake among men who are more likely to be diagnosed late. In 2019 85% of Caribbean women living with HIV were aware of their status as compared to 72% of men. There is also a need to increase testing coverage among members of key population communities who have reduced access to HIV services due to stigma and discrimination.

HIV self-testing is a process whereby a person collects saliva or pinprick blood specimen, performs a test, and receives the result in private. The World Health Organization (WHO) recommends that HIV self-testing be offered as an additional approach to the facility- and community-based services. Evidence shows that self-testing is safe and accurate and increases testing uptake among people who may not test otherwise. National policies should include a communication package with information to link testers to prevention and treatment services, as well as minimum standards for the procurement and distribution of HIV self-test kits in the private and public sectors.

“We strongly believe that HIV self-testing can help close the gap in the First 90. It can be targeted to individuals not being reached by existing HIV testing services, particularly those populations with low testing coverage and at high risk of HIV. It’s not a replacement for all testing services, but it should be included in the toolbox,” said Mrs Victoria Nibarger, PEPFAR Caribbean Regional Programme Coordinator.

At the launch, leaders from communities of people living with HIV and key populations endorsed the call for HIV self-testing. At the same time, they advised that increased investments are needed in post-test counselling and adherence counselling for the entire HIV response.

According to CMLF Director, Valerie Wilson, under the Global Fund Project for the region and in collaboration with PANCAP, the Caribbean Vulnerable Communities Coalition (CVC), the Centre for Orientation and Integral Research (COIN), the Organization of Eastern Caribbean States HIV/TB Elimination Project and PAHO, work is underway to conduct verification and feasibility assessment for the introduction of HIV self-testing within the region.

“HIV self-testing has the potential to be a high impact, low-cost intervention to reach population groups that are not testing and to increase the number of people living with HIV who are identified and have initiated treatment,” Mrs Wilson said.

Remarks by Dr Rosmond Adams, Director, PANCAP at the World AIDS Day 2020 Caribbean Virtual Panel Discussion and launch of the In Your Hands HIV Self-Testing Advocacy Campaign

Good Morning Everyone

Let me say thanks to the organizers for having PANCAP as part of this important discussion. Indeed, this is a demonstration of the type of solidarity that is needed at this critical time to confront global public health issues and to respond to the HIV/AIDS epidemic.

It is also a testimony of the shared responsibility that all must support whether individually of by our organizations doing our part in the response.

As we commemorate World AIDS Day 2020, the COVID-19 pandemic has further challenged our efforts to reach global targets on the road to ending AIDS.

Nonetheless, it has presented us with opportunities for us to look at the way we are doing things and to explore new and innovative approaches that are results-oriented. The epidemic is changing and so must our response also.

We cannot sit and continue to debate how can we increase testing and increase the number of people who know their HIV status without seizing the opportunity to explore and implement initiatives such as HIV self-testing.

HIV self-testing is safe, effective and simple to use. It empowers individuals and it puts the responsibility right into our own hands. It also will increase uptake of HIV testing services, especially for populations with low access to testing and those at higher risk that would otherwise not get tested.

There is still fear and stigma associated with the traditional HIV test. There is the fear of needles, the fear around confidentiality, etc. HIV self-testing can help to overcome some of these fears.

There are concerns in the health sector that persons may do the tests and may not be linked to care if they are tested positive. I am certain that with good support systems in place, individuals requiring care can be linked to care and we can get the data needed to monitor and evaluate programme effectiveness. Also, when individuals do the tests and they are aware of their status they will be empowered to be more responsible.

We at PANCAP fully endorse and support the push for HIV self-testing in our Region and we stand ready to support countries in implementing Combination HIV Prevention Programs with an aim to reaching everyone and ensuring that no one is left behind.

Message from Dr Rosmond Adams, Director, PANCAP on the occasion of World AIDS Day 2020

Message from Dr Rosmond Adams, Director, PANCAP on the occasion of World AIDS Day 2020

Each year, December 1 is commemorated as World AIDS Day, an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection, to recognise those who continue to work to end AIDS and to pause and remember those who have left us because of this disease.

The theme for World AIDS Day 2020 is, “Global solidarity, shared responsibility”. The Pan Caribbean Partnership against HIV and AIDS (PANCAP) endorses this theme as it effectively captures the phenomenal efforts of our public health champions in responding to the COVID-19 Pandemic while working to maintain the gains made in the HIV response.

Health care providers working in HIV have also been called to the battlefield to respond to COVID-19 a clear demonstration of the type of solidarity in health that is needed for us to live in a safe and healthy Caribbean.

The Coronavirus pandemic has disrupted health services. An effective HIV response requires continuous service delivery in areas such as prevention, treatment and laboratory services. Moreover, HIV care and treatment services are dependent on community action to reach those at risk and to support those currently living with HIV to ensure that they are reached and retained in care.

National AIDS Programmes and Civil Society across the Region continue to be challenged especially in the area of HIV testing as lockdowns, and other COVID-19 protocols have prevented persons from accessing services.  However, as the Region has proven in the past, rising to any challenge with collaboration and innovation is a hallmark of Caribbean people.

Public health practitioners across the Region have utilised strategic collaborations to respond to COVID-19 and protect the gains made in the HIV response.

In Belize, Enrique Romero, Executive Director, National AIDS Commission (NAC) used his alliances with social workers, adherence counsellors from the Ministry of Health (Belize), Peer Navigators, NAC District Committees and Civil Society Organizations (CSOs) to conduct a Needs Assessment of People Living with HIV.

The assessment revealed that many People Living with HIV were desperately in need of food items to remain adherent to their medication.  Enrique jumped into action, and within a few days, he worked tirelessly with the Ministry of Human Development, Social Transformation and Poverty Alleviation (Belize) to expedite assistance to these individuals through the Government of Belize’s “Food Assistance Programme”.

Loss of employment, lack of essential living support and depleting nutritional supplies are some of the main issues that undermine adherence to HIV medication.  COVID-19 has exacerbated these circumstances.

In Jamaica, Kandasi Levermore, Executive Director of the Jamaica AIDS Support for Life (JASL), responded to the needs of her clients by soliciting donations and writing proposals for small grants to provide clients with nutritional support, care packages, sanitisation items and financial support for transportation to attend clinic visits.  Such action in the face of so many adversities may have saved many lives and protected the gains made in the Region’s HIV response.

In Barbados, Dr Nastassia Rambarran and her team from Equals Barbados arranged for delivery of multi-month medication supplies, provided care via telemedicine and donated food hampers sourced from donations and an external grant.

These are just a few examples of our Caribbean Public Health Champions recognising their shared responsibility and taking decisive action to ensure the continuity of HIV services during COVID-19.

COVID-19 has thrown our National HIV Programmes and Civil Society into circumstances that demanded their best.  I am humbled and inspired by the response of our Public Health Practitioners and Civil Society leaders.  I have only highlighted a few of the best practices that have emerged from the Region, but there are many more success stories to share.

This World AIDS Day, I urge our Partners to share their stories and celebrate the success of maintaining the Region’s HIV response in the face of COVID-19.  Our Region has responded to the global Pandemic with cooperation, unity and innovation, which ensured the continuity of HIV services and better health outcomes for People Living with HIV.

Our Governments, National Programmes, community mobilisers and the private sector stepped up to provide the needed services so that People Living with HIV can remain on their medication.  Time will reveal how many lives were saved because our Region acted promptly and effectively.

I do believe that despite the challenges of 2020, our Region can amplify the HIV response and fulfil the mandate of the Caribbean Regional Strategic Framework on HIV and AIDS (CRSF) of a Caribbean free of AIDS and new HIV infections, in which all people are happier, healthier, productive, safe and respected.

We have demonstrated our ability to be innovative during this crisis. COVID-19 has disrupted the way we do things, but it has provided us with the opportunity to embrace change and innovation. Countries in the Region are now embracing innovations such as HIV self-testing, multi-month dispensing of ARVs and the use of digital technology to offer services virtually.

The Partnership remains committed to supporting this momentum, and we stand in solidarity with everyone as each of us does our part in ending AIDS in the Region.

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COVID-19 reshaping HIV services in the Caribbean

National AIDS Programmes continue to be challenged by the ongoing COVID-19 pandemic. Despite these challenges, they continue to deliver services to ensure the continuity of care. The delivery of services at this critical time requires reshaping the way that services are traditionally delivered. COVID-19 presents an opportunity to explore innovative solutions and new methods for service delivery.

Amongst the services significantly impacted by the pandemic disruptions is HIV testing. Persons requiring testing must access care at a health facility. Countries are now exploring the possibility of implementing HIV self-testing. HIV self-testing has the potential to rapidly increase uptake of HIV testing services, especially for populations with low access and those at higher risk that would otherwise not get tested. In areas where COVID-19 disruptions are high, self-testing is an ideal alternative to scale-up testing.

The pandemic has also opened up new avenues for the care of those who are stable and require fewer clinical interactions. By doing so, stable patients do not need to visit clinics as frequently as they did for medication and routine follow-up. Many programmes have implemented multi-month drug dispensing of antiretroviral therapy or ART for about three to six months. This has allowed care providers to devote more time to those with more urgent needs. It has also reduced the frequency that clients visit pharmacies to fill their prescriptions.

Many HIV programmes have also been embracing the use of digital technology. In some cases, clients are now able to book appointments online to avoid overcrowding in waiting rooms, especially in small clinics where physical distancing may not be possible. Also, some services, such as counselling and patient follow-up, are being conducted virtually.

Despite the disruptions from the pandemic, these new approaches are reshaping the way services are delivered. Most of these interventions still require close monitoring and evaluation to know if they are effective. Notwithstanding this, these interventions have the potential to reach more people and to deliver services in a quick, efficient and safe manner. They can change the way that care is provided beyond COVID-19.