“Everything is a Mess”: How COVID-19 is Impacting Engagement with HIV Testing Services in Rural Southwestern Uganda

Ponticiello, Matthew; Mwanga-Amumpaire, Juliet; Tushemereirwe, Patricia; Nuwagaba, Gabriel; King, Rachel; Sundararajan, Radhika

doi:10.1007/s10461-020-02935-w

Cited by 84 publications

(98 citation statements)

References 12 publications

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“…In China, a recent systematic review indicated an HIV prevalence of 5.7% (95% CI:5.4-6.1%) among MSM, with increasing HIV prevalence in this group over time (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) [3]. Efforts to manage the HIV epidemic in China have been made increasingly difficult by the emergent COVID-19 pandemic [4,5], having significant potential to affect the HIV care continuum and patterns of sexual risk behaviour in numerous settings worldwide [6][7][8][9][10]. Close examination of this syndemic is a key issue for global public health [11].…”

Section: Introductionmentioning

confidence: 99%

Estimating the impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China

Booton

MacGregor

et al. 2020

Preprint

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Introduction The COVID-19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV-related mortality. We estimated how COVID-19-related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China. Methods Regional data from China indicated that the number of MSM undergoing facility-based HIV testing reduced by 59% during the COVID-19 pandemic, alongside reductions in ART initiation (34%), numbers of sexual partners (62%) and consistency of condom use (25%). A deterministic mathematical model of HIV transmission and treatment among MSM in China was used to estimate the impact of these disruptions on the number of new HIV infections and HIV-related deaths. Disruption scenarios were assessed for their individual and combined impact over 1 and 5 years for a 3-, 4- or 6-month disruption period. Results Our China model predicted that new HIV infections and HIV-related deaths would be increased most by disruptions to viral suppression, with 25% reductions for a 3-month period increasing HIV infections by 5-14% over 1 year and deaths by 7-12%. Observed reductions in condom use increased HIV infections by 5-14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility testing and ART initiation, but reduced partner numbers resulted in 11-23% fewer infections and 0.4-1.0% fewer deaths. Longer disruption periods of 4 and 6 months amplified the impact of combined disruption scenarios. When all realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections was always predicted over one year (3-17%), but not over 5 years (1% increase - 4% decrease), while deaths mostly increased over one year (1-2%) and 5 years (1.2 increase - 0.3 decrease). Conclusions The overall impact of COVID-19 on new HIV infections and HIV-related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID-19 related disruption on HIV transmission and control among MSM in China.

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Section: Introductionmentioning

confidence: 99%

Estimating the impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China

Booton

MacGregor

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…11 Unsurprisingly, many are concerned that these disruptions will undermine Uganda's progress towards the UNAIDS Fast Track targets. 12…”

Section: Covid-19 and Hiv Care In Ugandamentioning

confidence: 99%

“…This reliance is driven by limited availability of HIV services and long travel distances. 12,16 Consequently, COVID-19-related travel restrictions and increasing levels of poverty have To restrict non-essential travel and gatherings, the Uganda Ministry of Health called for the temporary cessation of community mobilization for HIV testing and prevention services. 20 Although crucial for detecting and preventing new infections, especially in vulnerable populations, services such as mass mobile testing, pre-exposure prophylaxis, condom distribution, and health talks were cancelled or scaled back.…”

Section: Lockdown Measures: Travel Restrictions and Social Distancingmentioning

confidence: 99%

“…COVID-related stigma has also proved to be a significant barrier in accessing care. 12 Patients are hesitant to use healthcare facilities: "most of them are scared of going to hospital and contracting COVID-19 from the hospital" (Timothy M.M., Physician). 12 Others are concerned that symptoms related to HIV-associated infections such as tuberculosis will be mistaken by the public for COVID-19 and cause further discrimination and potentially aggression.…”

Section: Stigmamentioning

confidence: 99%

“…12 Patients are hesitant to use healthcare facilities: "most of them are scared of going to hospital and contracting COVID-19 from the hospital" (Timothy M.M., Physician). 12 Others are concerned that symptoms related to HIV-associated infections such as tuberculosis will be mistaken by the public for COVID-19 and cause further discrimination and potentially aggression. 16 COVID-19 has also exacerbated stigma-related barriers surrounding HIV: "Some [HIV] patients had challenges of [unwanted] disclosure of their status in this period because they needed their drugs" (Catherine Kunihira, Nurse).…”

Section: Stigmamentioning

confidence: 99%

See 2 more Smart Citations

Impact of the COVID-19 response in Uganda: “HIV-associated morbidity and mortality stands in the balance"

O'Connor¹,

Leung²,

Jung³

et al. 2020

UWOMJ

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The impact of disruptions due to COVID‐19 on HIV transmission and control among men who have sex with men in China

Booton

MacGregor

et al. 2021

J. Intern. AIDS Soc.

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Introduction The COVID‐19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV‐related mortality. We estimated how COVID‐19‐related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China, over a one‐ and five‐year time horizon. Methods Regional data from China indicated that the number of MSM undergoing facility‐based HIV testing reduced by 59% during the COVID‐19 pandemic, alongside reductions in ART initiation (34%), numbers of all sexual partners (62%) and consistency of condom use (25%), but initial data indicated no change in viral suppression. A mathematical model of HIV transmission/treatment among MSM was used to estimate the impact of disruptions on HIV infections/HIV‐related deaths. Disruption scenarios were assessed for their individual and combined impact over one and five years for 3/4/6‐month disruption periods, starting from 1 January 2020. Results Our model predicted new HIV infections and HIV‐related deaths would be increased most by disruptions to viral suppression, with 25% reductions (25% virally suppressed MSM stop taking ART) for a three‐month period increasing HIV infections by 5% to 14% over one year and deaths by 7% to 12%. Observed reductions in condom use increased HIV infections by 5% to 14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility HIV testing and ART initiation, but reduced partner numbers resulted in 11% to 23% fewer infections and 0.4% to 1.0% fewer deaths. Longer disruption periods (4/6 months) amplified the impact of disruption scenarios. When realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections occurred over one year (3% to 17%), but not for five years (1% increase to 4% decrease), whereas deaths mostly increased over one year (1% to 2%) and five years (1.2 increase to 0.3 decrease). Conclusions The overall impact of COVID‐19 on new HIV infections and HIV‐related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID‐19‐related disruption on HIV transmission and control among MSM in China.

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“Everything is a Mess”: How COVID-19 is Impacting Engagement with HIV Testing Services in Rural Southwestern Uganda

Cited by 84 publications

References 12 publications

Estimating the impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China

Estimating the impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China

Impact of the COVID-19 response in Uganda: “HIV-associated morbidity and mortality stands in the balance"

The impact of disruptions due to COVID‐19 on HIV transmission and control among men who have sex with men in China

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