Offering antiretroviral home deliveries for as little as R30 could drastically suppress HIV viral load among South African men, a new study has revealed.

Researchers from the Human Sciences Research Council and the University of Washington tested the home-delivery concept in Pietermaritzburg during the lockdown by recruiting men through a community-based testing programme.

In one group, men paid a fee of between R30 and R90 for home delivery, while another group continued receiving care from clinics.

The payment option was enthusiastically accepted, and after 47 weeks it had significantly increased viral suppression from 74% in the clinic group to 88% in the home delivery group.  

Research suggests men are less likely than women to seek help from health professionals for various problems, including HIV testing and treatment.

“It was reassuring to see that the clinic services were able to move to fast-track pickup of medication with maintenance of viral suppression, but overall the paid home delivery model worked significantly better, particularly among men, who can be harder to reach with clinic-based services,” said lead investigator Ruanne Barnabas, a professor of global health at the University of Washington School of Medicine.

According to findings presented this week at the virtual Conference on Retroviruses and Opportunistic Infections, the study team conducted the randomised trial from October 2019 to December 2020 among 162 people.

Barnabas said the study provides evidence that home delivery and monitoring of ART is convenient and overcomes logistical barriers.

It could also increase ART adherence and viral suppression, particularly among men. 

Another study presented at the conference - by Ezintsha, a research group within the Wits Reproductive Health and HIV Institute - revealed that fear of arrest, limited and crowded public transport and distrust of clinic infection control measures, were the major drivers of the disruption in HIV services in SA during the Covid-19 lockdown.

More than a million patients were affected by the disruptions.

HIV testing, antiretroviral initiations and male circumcision programmes ceased to operate for much of 2020.

“Fear was voiced by patients and families on several fronts,” said Prof Francois Venter, who heads the research group.

He said after media footage of soldiers forcing people off the streets into crowded shacks and more than 340,000 arrests, “many patients reported fear of being arrested while collecting their medication”.

Venter said foreigners were excluded from food parcel handouts and unemployment grants, while health-care workers dreaded going to work due to exposure to Covid-19, burnout and experiencing empathy fatigue.

“Shortages of protective equipment and labour demands for higher-than-necessary levels of equipment again speak to occupational fear reminiscent of HIV transmission concerns in the very early 1980s,” he said.

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