Feasibility, Affordability, Benefits, and Challenges of Transitioning to Virtual Case Management for PLHIV: Experiences From Indonesia and Nepal.

BACKGROUND: HIV case management supports people living with HIV to be linked to and retained in care. HIV case management becomes virtual case management (VCM) when some or all these services are provided via virtual tools or platforms including mobile phones, chat messenger apps, other mobile or web apps, and/or electronic case management systems. The COVID-19 pandemic accelerated the use and expansion of virtual services, including health services, across the globe. PROGRAM DESCRIPTION: These case studies document how HIV programs in Indonesia and Nepal transitioned from in-person case management to VCM during the COVID-19 pandemic in 2020. As part of this transition, the program in Nepal implemented VCM in 37 districts that were providing services to 12,820 people living with HIV (PLHIV), and in Indonesia the program supported 18,244 PLHIV in 5 districts. Data on the transition from in-person support to VCM were collected on client clinical outcomes, costs of the virtual services, and case manager feedback. RESULTS: These case studies indicate that VCM is a feasible and affordable approach to implement in low- and middle-income country contexts. Between March and September 2020, 10,995 (82.1%) and 3,801 (51.5%) PLHIV in Nepal and Indonesia, respectively, were supported by VCM. Continuity of care remained high in both countries with only 1%-2% interruptions in treatment. Viral load suppression also remained high in both countries (91%-92% in Indonesia and 94%-95% in Nepal). Viral load coverage, however, was low, but this was influenced by clinic and laboratory closures. Startup costs were low (<US$2,500), and the monthly cost per person to provide VCM was $2.34 in Nepal and $4.67 in Indonesia. Case manager feedback was focused on compensation, expanded reach of virtual services, gaps in client mobile phone ownership or digital literacy, efficiency of services, and confidentiality and privacy. CONCLUSION: VCM has transformative potential to expand the reach of health services and provide differentiated options, meeting clients' preferences and needs. The experiences and lessons learned from these two case studies can guide the implementation of future VCM programs in other countries.