Effects of the Coronavirus Disease 2019 Pandemic on Human Immunodeficiency Virus Services: Findings from 11 Sub-Saharan African Countries

Abstract

Background Concerns about the effects of COVID-19 pandemic on health services span the globe. We examined its effects on HIV services in sub-Saharan Africa. Methods Data collected quarterly [Q1: October-December 2019; Q2: January-March 2020; Q3: April-June 2020; Q4: July-September 2020] from 1,059 health facilities in 11 countries were analyzed and categorized by stringency of pandemic measures. We conducted a difference-in-differences assessment of HIV service changes from Q1-Q2 to Q3-Q4 by stringency category (high vs. low). Results There was a 3.3% decrease in the number HIV tested from Q2-Q3 (572,845 to 553,780). The number testing HIV-positive declined by 4.9% from Q2-Q3. In Q4, the number tested increased by 10.6% (612,646) from Q3, with increase by 8.8% with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2-Q3 but increased in Q4 by 9.8%. Across all quarters, the number currently on ART increased [419,028 (Q1) to 476,010 (Q4)]. The number receiving viral load (VL) testing in the past 12 months also increased [255,290 (Q1) to 312,869 (Q4)]. No decrease was noted in VL suppression (VLS) [87.5% (Q1) to 90.1% (Q4)]. HIV testing (p<0.0001) and new ART initiations (p=0.001) were inversely associated with stringency measures. Conclusions While initial declines were observed, rebound was brisk as the pandemic progressed, with increases noted in the number HIV tested, newly-initiated or currently on ART, VL testing, and VLS throughout the period, demonstrating substantial HIV program resilience in the face of the COVID-19 crisis.

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

“…A multi-site cohort study carried out in 1059 health facilities located in 11 sub-Saharan countries (Angola, Burundi, Cote d'Ivoire, Democratic Republic of Congo, Eswatini, Ethiopia, Kenya, Mozambique, South Sudan, and Zambia) suggested a transient negative effect on HIV testing and ART initiation followed by rapid recovery since more stringent measures were over. No impact was noted on viral load suppression [23]. Similar transient trend was documented in three African countries (Uganda, Kenya, Nigeria) registering a temporary decrease in HIV clinic visit adherence early in the pandemic, and an increase in viral suppression later in the pandemic [24].…”

Impact of the COVID‐19 pandemic on HIV prevention and care services among key populations across 15 cities in India: a longitudinal assessment of clinic‐based data

“…From a single tertiary hospital in India, researchers found that HIV testing dropped 57% in 2020 compared to 2019 with a similar decline for new diagnoses [16]. An analysis of HIV services in sub-Saharan Africa also saw HIV testing declines among general population clients; however, the decline associated with the initial COVID-19 wave was modest (∼3%) compared to our findings with a faster rebound [17]. In contrast, COVID-19 lockdowns in South Africa were found to correlate with nearly a 50% decline in testing in April 2020 with gradual improvement over time [18].…”

“…Qualitative data from other cities around India supported the success of MMD (vs. single month as was standard) as well as field/home delivery of ART [10], suggesting that the impacts on ART might have been less than preventive and testing services. Analyses from sub‐Saharan Africa found similar patterns, with a substantially smaller impact on ART use compared to HIV testing [17, 18]. Among MSM living with HIV across 20 countries, 20% reported they were unable to see their HIV provider because of pandemic mitigation strategies—notably lower than reported interruptions in HIV testing [20].…”

The impact of COVID-19 non-pharmaceutical interventions on HIV care continuum in China: An interrupted time series analysis

“… 37 A study of routine data from 65 public sector primary care clinics in Kwazulu–Natal province, South Africa, 6 found that the number of HIV tests declined by nearly 50% at the start of the lockdown, with gradual improvement over the next 3 months to pre-lockdown levels. A study of 11 sub-Saharan African countries 21 found a small decline in number of HIV tests early in COVID-19. The decrease in HIV diagnoses may be due to NPIs reducing the number of newly-infected cases by affecting people's sexual activity.…”