COVID-19 impacts on healthcare access in sub-Saharan Africa: an overview

Routine viral load (VL) monitoring is the standard of care in Côte d’Ivoire and allows for effective treatment guidance for people living with human immunodeficiency virus (HIV) to reach viral load suppression (VLS). For VL monitoring to be effective in reducing the impact of HIV, it must be provided in accordance with national guidance. This study aimed to evaluate VL testing, VLS rates and adherence to national guidance for VL testing using data collected from three national laboratories. We collected data on VL testing between 2015–2018 from OpenELIS (OE), an open-source electronic laboratory information system. We merged data by unique patient ID for patients (0–80 years old) who received multiple VL tests to calculate time between tests. We defined VLS as HIV RNA ≤1,000 copies/mL based on Côte d’Ivoire national and WHO guidance at the time of data collection. We used the Kaplan-Meier survival estimator to estimate time between ART (antiretroviral therapy) initiation and the first VL test, time between subsequent VL tests, and to estimate the proportion of people living with HIV (PLHIV) who were virally suppressed within 12 months of ART initiation. At the first documented VL test, 79.6% of patients were virally suppressed (95% CI: 78.9–80.3). Children under 15 were the least likely to be virally suppressed (55.2%, 95% CI: 51.5–58.8). The median time from ART initiation to the first VL sample collection for testing was 7.8 months (IQR:6.2–13.4). 72.4% of patients were virally suppressed within one year of treatment initiation (95% CI:71.5–73.3). Approximately 30% of patients received a second VL test during the 4-year study period. The median time between the first and second VL tests was 24.9 months (IQR: 4.7->40). Most PLHIV received their first VL test within the recommended 12 months of ART initiation but did not receive subsequent VL monitoring tests within the recommended time frame, reducing the benefits of VL monitoring. While VLS was fairly high, children were least likely to be virally suppressed. Our findings highlight the importance of regular VL monitoring after the first VL test, especially for children.

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A Four Years Longitudinal Study of Childhood Vaccination Trends and Supply Chain Resilience in Tanzania amid COVID-19 Pandemic

Sangeda,

James,

Mariki

et al. 2023

Preprint

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Background The COVID-19 pandemic has significantly disrupted healthcare systems at all levels globally, notably affecting routine healthcare services such as childhood immunisations. This study delves into the impact of these disruptions on routine childhood vaccination programs in Tanzania. Methodology We conducted a longitudinal study over four years in five Tanzanian regions: Mwanza, Dar es Salaam, Mtwara, Arusha, and Dodoma. The study analysed trends in the usage of six key vaccines: Bacille Calmette-Guérin (BCG), Bivalent Oral Polio Vaccine (bOPV), Diphtheria Tetanus Pertussis, Hepatitis-B and Hib vaccine (DTP-HepB-Hib), measles-rubella (MR), Pneumococcal Conjugate Vaccine (PCV), and Rota vaccines. We evaluated annual and monthly vaccination trends using time series and regression analyses. Predictive modelling was performed using an Autoregressive Integrated Moving Average (ARIMA) model. Results The study recorded a total of 32,602,734 vaccination events across the regions from 2019 to 2022. Despite declining vaccination rates in 2020, there was a notable rebound in 2021, indicating the resilience of Tanzania's immunisation program. The analysis also highlighted regional differences in varying vaccination rates when standardised per 1000 population. Seasonal fluctuations were observed in the monthly vaccination rates, with BCG showing the most stable trend. Predictive modelling of BCG indicated stable and increasing vaccination coverage through 2023. Conclusion The findings underscore the robustness of Tanzania's childhood immunisation infrastructure in overcoming the challenges posed by the COVID-19 pandemic, marked by a strong recovery in vaccination rates post-2020. We provide valuable insights into the dynamics of vaccinations during a global health crisis and highlight the importance of sustained immunisation efforts in maintaining public health.

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COVID-19 impacts on healthcare access in sub-Saharan Africa: an overview

Cited by 4 publications

References 118 publications

Changes in the global hospitalisation burden of respiratory syncytial virus in young children during the COVID-19 pandemic: a systematic analysis

Changes in the global hospitalisation burden of respiratory syncytial virus in young children during the COVID-19 pandemic: a systematic analysis

HIV viral load testing and monitoring in Côte d’Ivoire: A survival analysis of viral load testing and suppression, and evaluation of adherence to national recommendations

A Four Years Longitudinal Study of Childhood Vaccination Trends and Supply Chain Resilience in Tanzania amid COVID-19 Pandemic

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