Experiences of participants in a decentralized HIV medication distribution program in South Africa during the COVID-19 pandemic

Background: Restrictions on social interaction and mobility during the COVID-19 pandemic could adversely impact long-term HIV care, particularly in areas of high HIV prevalence such as South Africa Decentralized antiretroviral therapy (ART) programs, which allow stable patients to collect ART at community-based pick-up points, have the potential to improve care by decongesting clinics and decreasing barriers to ART access We aimed to evaluate the experiences of people receiving HIV care through a decentralized program in South Africa during the COVID-19 pandemic Methods: We telephoned a random subsample of 604 participants enrolled in a larger prospective cohort study of the Central Chronic Medicine Dispensing and Distribution Program (CCMDD) in urban Kwazulu-Natal A semi-structured telephone interview included questions about general concerns regarding the COVID-19 pandemic and national lockdown, and changes in access to HIV care and ART Results: We completed interviews with 280 participants (46%) of whom 66% were female, median age was 37y, and median time of enrollment in the CCMDD program was 6 7 months The most common concern among participants regarding the COVID-19 pandemic was food running out, cited by 113 (40%) of participants, followed by becoming infected (n = 99;35%), being unable to work (n = 85, 30%), and money running out (n= 80;29%) Primary concerns regarding ART pick-up in the future were COVID-19 infection risk (91, 33%), transportation availability (63, 22%), and safety (58, 21%) Twenty (7%) of 278 participants had recently delayed picking up their ART due to COVID-19 Among those with available data, 40 (30% of 143) reported an increase in time to travel to their medication pick-up point, and 71 (49% of 144) reported an increase in wait-times Conclusions: Participants in a decentralized ART program in South Africa identified socioeconomic concerns and fear of COVID-19 infection during the national lockdown for COVID-19 mitigation While a small number had delayed picking up ART due to COVID-19, a significant proportion had concerns about accessibility and safety of medication pick-up going forward, and many reported new barriers to picking up their medication Strategies for maintaining access to longitudinal HIV care during the COVID-19 pandemic in South Africa are needed