COVID-19 associated changes in HIV service delivery over time in Central Africa: Results from facility surveys during the first and second waves of the pandemic

Abstract

Introduction The COVID-19 pandemic has impacted population health around the globe, directly and indirectly. The objective of this study was to document changes in HIV care associated with the COVID-19 pandemic at selected clinics in Central Africa, along with clinic-level strategies for minimizing disruptions in HIV care and treatment for people with HIV (PWH). Methods A 51-item questionnaire on COVID-19 pandemic-associated changes in HIV service delivery was completed by clinicians involved in HIV care at 21 clinics in five countries participating in Central Africa International epidemiology Databases to Evaluate AIDS (CA-IeDEA). The survey was completed at two timepoints: June-July 2020 and October 2020 to February 2021. Descriptive statistics were used to characterize changes in HIV care and related services. Results While 81% of sites reported at least one negative consequence of COVID-19 for clinic operations during the first survey, none reported suspending antiretroviral therapy (ART) initiation services for new patients, and 24% reported adopting telemedicine. In the follow-up survey, fewer sites (48%) reported at least one disruption to clinic operations, and more sites reported mitigation strategies, including expanding rapid ART initiation services and providing extra supplies of ART medications to reduce visit frequency. In the follow-up survey, more sites, especially in Rwanda, reported stockouts of commodities, including HIV and viral load testing and HIV pre-exposure prophylaxis. More than one-fifth of sites reported stockouts of second- or third-line ART at each survey timepoint. Conclusions While the initial wave of the COVID-19 pandemic resulted in concerning disruptions to HIV service delivery at CA-IeDEA sites, most of these disruptions attenuated over time, and many sites introduced measures to help PWH avoid frequent visits to the clinic for care and medications. The impact of HIV commodity stockouts and clinic mitigation strategies on treatment outcomes needs to be assessed.

Assessing the resilience of HIV healthcare services provided to adolescents and young adults after the COVID-19 pandemic in the city of Beira (Mozambique): an interrupted time series analysis

“…Among the HIV services most affected by the COVID-19 pandemic along with the number of HIV tests were community programs, such as community support groups, patient tracing activities and outreach activities [ 28 ]. The data from our study showed how re-engagement activities were heavily affected by the pandemic, with a decrease compared to the pre-pandemic period, and even at the beginning of the post-pandemic period, the recall ratio made by community health care workers was still at a lower level than in the pre-pandemic period.…”

“…In the present study, no differences in HIV service delivery were found based on the HC being located in a central or peripheral area within an urban setting. This may be due to the fact that HCs located in rural areas were not included in the study, as these areas showed the greatest fragility and difficulties in HIV service delivery as they are also highly reliant on community-based activities [ 28 , 35 ]…”

Syndemic effect of COVID-19 outbreak on HIV care delivery around the globe: A systematic review using narrative synthesis

“…It has been found that few countries have adopted multi-month dispensing of drugs 8 , 13 , 22 , 32 while most of the countries could not, due to a shortage of drugs. Such a buffer to health systems against external shocks is advisable.…”

“…For example, teleconsultation or virtual platforms, 9 , 12 , 18 , 22 , 23 , 25 , 26 , 28 , 37 was adopted for the smooth functioning of routine HIV care services. In some countries, home delivery 30 of ART medications, multi-month dispensing of ART, 6 , 8 , 13 , 32 provision of self-testing 14 , 20 , 33 and nutritional support 29 were adopted.…”

Long-term HIV care outcomes under universal HIV treatment guidelines: A retrospective cohort study in 25 countries

“…Observed decreases in VL monitoring at 36 months are surprising because the subset of patients enrolling in HIV care after guideline adoption with at least 36 months of follow-up time comprised more patients from high-income countries with greater capacity for VL testing [25]. Additionally, while the COVID-19 pandemic is known to have disrupted HIV-related services in many settings [26,27], most patients in our study (>95%) were in countries adopting universal treatment guidelines in 2016 or earlier, meaning that VL monitoring at 36 months after ART initiation reflected prepandemic VL monitoring practices. In sensitivity analyses that excluded countries where outcomes at 36 months could have coincided with the COVID-19 pandemic findings were consistent with our main analyses.…”