TABLE. Adaptations of the national human immunodeficiency virus (HIV) testing and treatment program during the COVID-19 outbreak — Namibia, 2020.

Program area	Program adaptations
Clinic readiness	Screening and triaging clients for COVID-19 symptoms
	Adjusting clinic flow to limit overcrowding and exposure risk for patients and health care workers
	Limiting clinic appointments to avoid crowding (prioritizing patients failing ART or clinical complaints)
	Providing ART refills without entering the facility
	Providing expedited services for patients at higher risk for COVID-19 morbidity and mortality
	Using Project ECHO platform for regular communication, coordination and telementoring for all regions
	Providing virtual COVID-19 trainings for staff members
	Providing PPE
MMD of ART (adults, children, and pregnant and breastfeeding women)	Assessing national stock situation and adjusting ART guidance to ensure adequate medication stock for MMD
	Issuing and widely sharing interim ART guidance through ECHO and clinical mentorship network
	Distributing stock to regions to ensure adequate supplies for MMD
Community dispensing	Using community-based ART outreach points
	Adapting and expanding community adherence groups with groups <10 at one time
	Expanding primary health care outreach points
	Using mobile vans (especially for persons at high risk and for those unable to get MMD)
	Establishing home delivery (through community health care workers)
Patient tracing	Shifting physical tracing of patients missing appointments to phone tracing exclusively
Strengthening border services	Liaising with regional governments, immigration authorities, and police to allow patients to access medicines
	Creating outreach points for patients to access ART at the Angola-Namibia border
	Tracing patients who miss appointments via telephone to link them back into care
	Establishing ART hotline to assist patients having difficulty accessing services and answer questions about COVID-19 and HIV
Facility HIV testing	Prioritizing facility-based testing (antenatal care, admitted patients, early infant diagnosis, persons with tuberculosis and sexually transmitted infections, passive index testing)
	Standardizing safe HIV testing services provision using physical distancing and PPE measures
	Maximizing use of self-testing kits* outside of clinic settings for clients and their partners
Community index testing	Discontinuing community index testing until safe processes were established
	Providing guidance for proper PPE use to implement community index testing once deemed safe
HIV recency testing	Pausing recency testing to decrease time spent in clinics and decrease burden on laboratory staff members
Community adolescent treatment supporters and teen clubs	Providing community adolescent treatment supporters with mobile phones and airtime to continue to engage beneficiaries from home
	Limiting teen clubs to continue meeting in only places where they could practice recommended physical distancing with no more than 10 teens at a time
Cervical cancer screening and treatment	Continuing limited screening at health facilities that have program-specific staff members
	Postponing all outreach and campaigns
Tuberculosis preventive therapy	Dispensing tuberculosis preventive therapy for the full duration of treatment for those initiating or already receiving tuberculosis preventive therapy
	Delivering tuberculosis preventive therapy medications to eligible clients through community health care workers with recommended PPE and physical distancing
Prevention of mother-to-child transmission of HIV	Continuing routine testing of pregnant and breastfeeding women and HIV-exposed infants
	Providing MMD for pregnant and breastfeeding women
	Prioritizing safe labor and delivery access in health care facilities with adjustments in clinic flow to minimize the risk for COVID-19 exposure
	Providing pregnant and breastfeeding women adherence and retention support through telephone calls

Abbreviations: ART = antiretroviral therapy; COVID-19 = coronavirus disease 2019; MMD = multimonth dispensing; PPE = personal protective equipment; Project ECHO = Extension for Community Healthcare Outcomes.

* OraSure Technologies. http://www.oraquick.com.