Despite the presence of COVID-19 in Zanzibar, there was an increase in the number of clients tested from July to December 2020 compared to January to June 2020, with a pronounced increase in the number of clients tested positive from 0.6% of January to June 2020 to 0.7% of July to December 2020. The increased number of HIV testing clients and tested positive were due community outreach services of index testing and counselling services across the country. These results contrasted with those found in Japan, where providing COVID-19-related services became the primary burden at healthcare facilities as the number of tests completed in 2020 sharply decreased from 142,000 in 2019 to 69,000 in 2020 [8].
On the other hand, this report shows that the proportion of pregnant women who received antiretroviral therapy (ART) to lower the risk of mother-to-child transmission (91.7%), the proportion of infants born to HIV-positive mothers who had an HIV virological test within 2 months (87.6%), and the proportion of pregnant women who were aware of their positive HIV status (91.6%) all decreased between July and December 2020 in comparison to January-June 2020. Similar to this, the COVID-19 pandemic has hampered efforts in South Africa to limit mother-to-child HIV transmission (PMTCT). This remark was made during the interviews with 40 migrants, including 18 from within the country and 22 from overseas. This was brought on by border restrictions that hampered compliance and restricted their access to ARVs throughout the pandemic [9].
In comparison to January to June 2020, when key populations (MSM, FSW and PWID) were reached (6353), tested (5516), and found to be positive (120), fewer key populations were reached (2883), tested (2768), and identified as HIV-positive (73) between July and December 2020. An Indian study found that the initial shutdown had a significant impact on HIV testing for all typologies. The FSW, MSM, and Transgender numbers quickly bounced back after the unlock period [10].
The COVID-19 epidemic had a substantial effect on HIV care and treatment in Zanzibar. According to the institutions, there were 211 fewer new customers enrolled in April–June 2020 than in the other quarters of 2020, which had an effect on the number of clients receiving care and treatment (6797 and 6604). In order to determine how COVID-19 affects HIV care generally, Ellen et al. conducted a survey that identified 46 ART locations in Africa and the Asia–Pacific area. The COVID-19 epidemic caused some disruptions in the routine care and medical services at about 90% of the participating ART centres [11].
Zanzibar has put strict precautions in place to prevent the COVID 19 from spreading, like restricting hospital visitors. The provision of essential HIV services, such as care and treatment, services for key population, and PMTCT, was unintentionally hampered by these actions, despite the fact that they were necessary. Because they fear stigma associated with having to present their identity cards at the facility entrance main gate due to their undisclosed status, People Living with HIV (PLHIV) have difficulty accessing the care they need, including antiretroviral therapy (ART) and other important medications. Many hospitals and health facilities are working under partial capacity. Patients visiting these hospitals are needed to present a referral letter or proof that they are registered at a certain clinic. In this challenging time, the ARV 3-multi-month dispensing (3MMD) policy has been successfully implemented in all clinics for all stable clients who are 5 years of age or older, have received ART for at least 6 months, are free of adverse drug reactions that require regular monitoring, are not suffering with comorbidities and opportunity infections, have a good understanding of lifelong adherence of 95% and kept clinic visit appointments for the past 6 months, and are on first-line ARVs/second-line ARV with undetectable viral load (VL below 50 copies/ml). The vast majority of ART users in Zanzibar are represented by this group [7].
Additionally, a block system was implemented in Mnazi mmoja and Muembeladu CTCs to relieve client congestion and overcrowding. Clients were arranged in specific numbers, times, and dates for appointments to refill ARVs. Also, Fast Track Delivery of ARVs as Community Outreach Services to all stable clients through 3MMD was implemented at the Zanzibar People Living with HIV office (ZAPHA+), which is located at Welezo outside of Zanzibar town.
Campaigns to raise awareness of COVID-19 prevention and treatment have been run through a variety of media, including the Zanzibar Broadcasting Cooperation's (ZBC) television and radio, bronchures, and banners, in order to protect the general state of PLHIV in Zanzibar.
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