Antiretroviral treatment interruption among people living with HIV during COVID‐19 outbreak in China: a nationwide cross‐sectional study

Abstract

Introduction Social disruption associated with coronavirus disease 2019 (COVID‐19) threatens to impede access to regular healthcare, including for people living with HIV (PLHIV), potentially resulting in antiretroviral therapy (ART) interruption (ATI). We aimed to explore the characteristics and factors associated with ATI during the COVID‐19 outbreak in China. Methods We conducted an online survey among PLHIV by convenience sampling through social media between 5 and 17 February 2020. Respondents were asked to report whether they were at risk of ATI (i.e. experienced ATI, risk of imminent ATI, threatened but resolved risk of ATI [obtaining ART prior to interruption]) or were not at risk of ATI associated with the COVID‐19 outbreak. PLHIV were also asked to report perceived risk factors for ATI and sources of additional ART. The factors associated with the risk of ATI were assessed using logistic regression. We also evaluated the factors associated with experienced ATI. Results A total of 5084 PLHIV from 31 provinces, autonomous regions and municipalities in mainland China completed the survey, with valid response rate of 99.4%. The median age was 31 years (IQR 27 to 37), 96.5% of participants were men, and 71.3% were men who had sex with men. Over one‐third (35.1%, 1782/5084) reported any risk of ATI during the COVID‐19 outbreak, including 2.7% (135/5084) who experienced ATI, 18.0% (917/5084) at risk of imminent ATI and 14.4% (730/5084) at threatened but resolved risk. PLHIV with ATI were more likely to have previous interruptions in ART (aOR 8.3, 95% CI 5.6 to 12.3), travelled away from where they typically receive HIV care (aOR 3.0, 95% CI 2.1 to 4.5), stayed in an area that implemented citywide lockdowns or travel restrictions to control COVID‐19 (aOR 2.5, 95% CI 1.4 to 4.6), and be in permanent residence in a rural area (aOR 3.7, 95% CI 2.3 to 5.8). Conclusions A significant proportion of PLHIV in China are at risk of ATI during the COVID‐19 outbreak and some have already experienced ATI. Correlates of ATI and self‐reported barriers to ART suggest that social disruptions from COVID‐19 have contributed to ATI. Our findings demonstrate an urgent need for policies and interventions to maintain access to HIV care during public health emergencies.

Stakeholder efforts to mitigate antiretroviral therapy interruption among people living with HIV during the COVID‐19 pandemic in China: a qualitative study

“…We found that travel restrictions and home quarantine measures made it difficult for some PLHIV in China to refill ART from the designated CDC clinics or hospitals where they typically receive HIV care. This finding is consistent with large-scale nationwide surveys of PLHIV in China where risk of ART interruption was correlated with travel away from home and living in areas that implemented citywide lockdowns during the COVID-19 pandemic [11]. Despite nationwide policy reform efforts by the Chinese central government, PLHIV found local CDC clinics and hospitals to be slow and inconsistent in operationalizing policies designed to minimize the impact of COVID-19 control measures on HIV care.…”

Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya

“…We only assessed referral to ART and did not measure initiation and retention on ART. Previous studies have suggested that ART interruption has been a problem during the COVID-19 pandemic [42], and it would have been interesting to assess this in Kenya. We also did not assess treatment outcomes of patients with drug-resistant TB, but these patients would have been referred to other centers where the ability to track outcomes might have been difficult with COVID-19 restrictions in place.…”

Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe

“…We only assessed referrals of HIV-positive persons to ART and did not document the initiation or retention on ART. Previous studies have suggested that ART interruption has been a problem during the COVID-19 pandemic [ 39 ]. It would have been interesting to assess this in Zimbabwe, especially as interruption to ART is thought to be one of the most important determinants of HIV-related mortality during the COVID-19 pandemic [ 40 ].…”