Barriers and facilitators to implementing six monthly multi-month dispensing of antiretroviral therapy in two urban HIV clinics during the COVID-19 Era in Malawi

Abstract

Following the COVID-19 pandemic, the Malawi Government released a policy that promoted the scale-up of six-monthly multi-month dispensing (6-MMD) of antiretroviral therapy (ART) to people living with HIV in order to decrease congestion at health facilities and transmission of COVID-19. We evaluated the barriers and facilitators to implementing the scale-up of 6-MMD.We conducted a cross-sectional study and collected quantitative and qualitative data from 13 January 2022 to 5 February 2022 at two high-volume primary health facilities in urban Blantyre, Malawi. A survey was self-administered to healthcare workers (HCWs) and a subset were purposively selected for key informant interviews. The interviews were guided by the consolidated framework for implementation research and questions focused on perceived barriers and facilitators to 6-MMD. We calculated proportions of reported barriers and facilitators based on the Likert scale. A thematic content analysis was done for qualitative data. Of the 77 HCWs who participated in the surveys, 56 (73%) were female and 22 (29%) were nurses. Major barriers to the implementation of 6-MMD were low drug supply and lack of understanding of the policy. Other reported barriers were s missing clinic appointments and viral load sample collection, if timelines for ART dispensation and viral load testing were misaligned. The major facilitators were orientation and review meetings, teamwork among staff, and the use of the electronic medical records system to track patients. Additionally, reduction in the number of patient visits, which reduced the workload of healthcare workers was cited as another motivator for implementing 6-MMD. Major facilitators to transition to 6-MMD included health care worker capacity building, teamwork and use of electronic medical records while major barriers included low drug supplies and lack of understanding of policy guidance. These findings may be helpful when developing strategies for increasing coverage and uptake of 6-MMD of ART.