The following frequently asked questions (FAQs) are intended to provide additional information on PEPFAR’s HIV response in the context of the novel coronavirus (COVID-19). For even more detailed information on the technical guidance that PEPFAR is providing to our country and regional teams, you may access it [1 MB].
What are PEPFAR’s top priorities in the context of COVID-19?
PEPFAR remains deeply committed to advancing global progress toward controlling the HIV epidemic and providing access to lifesaving HIV prevention and treatment services in the context of the novel coronavirus (COVID-19). To continue to serve, support, and protect our clients, communities, staff, and partners around the world, we are focused on four priority areas.
- Ensuring continuity of care for people living with HIV
- Leveraging PEPFAR-supported health systems and infrastructure
- Reducing exposure of staff and HIV clients to health care settings that may be overburdened and/or sources for potential exposure to COVID-19
- Providing flexibility for PEPFAR programs in how to optimally serve our HIV clients in areas affected by COVID-19
How is PEPFAR ensuring continuity of care for people living with HIV in the context of COVID-19?
PEPFAR is committed to ensuring that the people living with HIV who we serve continue to receive the lifesaving antiretroviral therapy (ART) to stay healthy and maintain virologic suppression. For example, we are working to provide at least three months, and ideally six months, of ART for our clients, and to the greatest extent possible proving ART refills outside of health care facilities.
What is PEPFAR doing to reduce the risk of potential exposure to COVID-19 among its clients and staff?
PEPFAR is minimizing client visits to health care settings for non-essential services to reduce their risk of potential exposure to COVID-19, protect frontline health care workers, and avoid unnecessarily taxing overburdened health care settings. We are adapting HIV service delivery models to ensure social distancing, reduce contact of well persons with health care settings, and limit or pause any service provision that cannot be conducted within appropriate guidelines. We have advised that individuals with proven or suspected COVID-19 should be separated from locations where care is provided to other clients. Dedicated HIV clinic spaces (where they do not already exist) may be useful in accomplishing this goal.
What flexibility is PEPFAR providing its teams in the context of COVID-19?
In close consultation with partner governments, PEPFAR is providing our country and regional teams with greater flexibility to determine how to optimally serve our HIV clients with prevention and treatment services in areas affected by COVID-19 based on the specifics of their local context. This includes taking steps to protect U.S. government staff, our implementing partners, clients, health care workers, and the broader community. We are continually monitoring the conditions in each country and region and will make any additional modifications that are required.
What is known about how COVID-19 affects people living with HIV?
The evidence on the impact of COVID-19 amongst people living with HIV (PLHIV) is still scarce. There is currently no direct evidence that PLHIV are at higher risk of contracting COVID-19 or of having severe disease if infected with COVID-19. As more data become available from regions of high prevalence we will continue to provide updates. HIV virologic suppression remains a critical intervention that improves the health of all PLHIV.
What treatments are available for COVID-19?
Currently, there is no known effective treatment for COVID-19. PEPFAR discourages the use of experimental therapies outside of registered clinical trials as they may be dangerous. Drug-drug interactions with antiretroviral therapy and other HIV related therapies may pose particular risks for people living with HIV.
What is the role of antiretroviral medications in the treatment of COVID-19?
There is no evidence that regimens based on dolutegravir or efavirenz, which account for greater than 90 percent of all HIV treatment in PEPFAR-supported program, have any role in treating COVID-19. Lopinavir/r is being investigated for use in the context of COVID-19, but there is no conclusive evidence at present supporting its efficacy in this application; a recent clinical trial failed to show a benefit.
How can PEPFAR-supported health systems be leveraged in the context of COVID-19?
PEPFAR invests more than $900 million annually to support health systems infrastructure and capacity in our partner countries, including expertise in surveillance, laboratories, and public health response, of which more than $140 million assists over 3,000 laboratories and 28 national reference laboratories – the vast majority in Africa. We are working to leverage this robust laboratory capacity and surveillance systems to support diagnostics for COVID-19 at the appropriate time and to ensure these systems continue to function for people living with, and communities affected by, HIV.
Is PEPFAR planning for potential HIV service disruptions in the context of COVID-19?
We are undertaking contingency planning and prioritization for all PEPFAR programs in the context of current and potential future disruptions. PEPFAR is built on a foundation of data-driven continuous planning, monitoring, review, adaption, and innovation. This tradition will remain strong in the context of COVID-19 as does our unwavering commitment to the people and communities we serve around the world.