HIV treatment engagement in the context of COVID-19: an observational global sample of transgender and nonbinary people living with HIV

Abstract

Background HIV services, like many medical services, have been disrupted by the COVID-19 pandemic. However, there are limited data on the impacts of the COVID-19 pandemic on HIV treatment engagement outcomes among transgender (trans) and nonbinary people. This study addresses a pressing knowledge gap and is important in its global scope, its use of technology for recruitment, and focus on transgender people living with HIV. The objective of this study is to examine correlates of HIV infection and HIV treatment engagement outcomes (i.e., currently on ART, having an HIV provider, having access to HIV treatment without burden, and remote refills) since the COVID-19 pandemic began. Methods We utilized observational data from the Global COVID-19 Disparities Survey 2020, an online study that globally sampled trans and nonbinary people (n = 902) between April and August 2020. We conducted a series of multivariable logistic regressions with lasso selection to explore correlates of HIV treatment engagement outcomes in the context of COVID-19. Results Of the 120 (13.3%) trans and nonbinary people living with HIV in this survey, the majority (85.8%) were currently on HIV treatment. A smaller proportion (69.2%) reported having access to an HIV provider since COVID-19 control measures were implemented. Less than half reported being able to access treatment without burdens related to COVID-19 (48.3%) and having the ability to remotely refill HIV prescription (44.2%). After adjusting for gender in the multivariable models, younger age and anticipated job loss were significantly associated with not having access to HIV treatment without burden. Outcomes also significantly varied by geographic region, with respondents reporting less access to an HIV provider in nearly every region outside of South-East Asia. Conclusion Our results suggest that currently taking ART, having access to an HIV provider, and being able to access HIV treatment without burden and remotely refill HIV medication are suboptimal among trans and nonbinary people living with HIV across the world. Strengthening support for HIV programs that are well-connected to trans and nonbinary communities, increasing remote access to HIV providers and prescription refills, and providing socioeconomic support could significantly improve HIV engagement in trans and nonbinary communities.

Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review

“…Studies were conducted in more than 34 countries. Of all included studies, 10 were conducted in multiple countries (five or more),79 80 85 90 105–110 six of which spanned multiple geographical regions 105–110. While most studies (61%) did not specify setting, a quarter took place in urban or periurban regions,32 37 38 40 46 48 52 55 56 59 63–66 71 72 81 88 89 96–99 8% in rural areas57 58 60 68 73 91 103 and 7% directly compared outcomes in urban versus rural areas 51 54 61 69 75 87 Online supplemental table 1.…”

“…displays the characteristics of included studies. There was a relatively even distribution of studies across SRH focus areas: 30 (36%) provided evidence on the impact of the COVID-19 pandemic on access to or utilisation of contraceptive services,28 29 32 35 37 40 42 47 51–54 57 58 63 67 68 71 73 75 78 82 83 88 91 93 97 104 109 110 21 (25%) on abortion services,30 32–35 40 43 49–52 68 73 80 87 89 90 93 99 103 109 20 (24%) on GBV/IPV services28 31 36 38 39 45 46 48 74 76 77 81 84 86 98 101 102 105 107 109 and 33 (40%) on STI-related services 35 40 41 44 53 55–62 64–66 69–73 79 85 91–96 100 104 106 108 Figure 2. illustrates the distribution of studies among each of the four SRH service focus area by region and by study type.…”

“…Nearly half of included studies (40, 48%) found a decrease in access or utilisation of STIs/HIV services 35 40 41 44 53 55–62 64–66 69–73 79 85 91–96 100 104 106 108. STI testing reductions were reported in Uganda,53 the USA,35 Jordan,104 Thailand95 and Uganda 60.…”

“…Evidence of the negative impact of the pandemic on access to services for treatment and management of STIs was reported by 14 studies 40 53 59 62 64 69 71 92–95 100 104 106. Difficulty accessing antiretroviral treatment (ART) was reported in several countries with a high incidence of HIV, including Zimbabwe,59 Uganda,53 64 South Africa,69 Kenya71 and Haiti,100 as well as Myanmar,94 Thailand,95 China92 93 and the USA 40.…”

“…Restar (mixed) 106 COVID-19 imposed burdens on accessing HIV treatment and prescription refills among trans and non-binary people living with HIV; nearly one-third of respondents reported not having access to an HIV provider since pandemic control measures were implemented.…”