Impact of COVID-19 on Adolescent HIV Prevention and Treatment Services in the AHISA Network

Abstract

We investigated perceived impacts of COVID-19 on the delivery of adolescent HIV treatment and prevention services in sub-Saharan Africa (SSA) by administering a survey to members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) from February to April 2021. We organized COVID-19 impacts, as perceived by AHISA teams, under three themes: service interruptions, service adjustments, and perceived individual-level health impacts. AHISA teams commonly reported interruptions to prevention programs, diagnostic testing, and access to antiretroviral therapy (ART). Common service adjustments included decentralization of ART refills, expanded multi-month ART distribution, and digital technology use. Perceived individual-level impacts included social isolation, loss to follow-up, food insecurity, poverty, and increases in adolescent pregnancies and sexually transmitted infections. The need for collaboration among stakeholders were commonly cited as lessons learned by AHISA teams. Survey findings highlight the need for implementation science research to evaluate the effects of pandemic-related HIV service adaptations in SSA.

Impact of COVID-19 on HIV Adolescent Programming in 16 Countries With USAID-Supported PEPFAR Programs

“…5–8 Recorded impacts of the COVID-19 pandemic on the lives of adolescents include prolonged school closure, increased economic hardship, social isolation, reduced food intake, increased gender-based violence, and an uptick in teenage pregnancy. 9–12 Furthermore, many adolescents have experienced negative mental health outcomes as a result of COVID-19, with decreased access to psychosocial support. 13–15 In addition, findings from South Africa and the United States demonstrate that ALHIV on treatment experienced increased vulnerabilities during the pandemic, including economic loss, food insecurity, and treatment interruptions.…”

Generalized and COVID related anxiety as risk factors for health outcomes among adolescents with HIV during COVID-19 in Tanzania

“…Individual-level impacts included feelings of social isolation, loneliness, loss to follow-up, food insecurity, poverty, and increases in adolescent pregnancies and sexually transmitted infections [10]. Many studies have also reported an increased risk of anxiety, depression, feeling lonely, and a reduction in the quality of life among adolescents during the COVID-19 lockdown because of these stressors [44][45][46].…”

“…A four-point Likert scale provides scores of 0-3 for responses to each item as "not at all", "on several days", "on more than half the days", and "nearly every day", with a summed scores range of 0-21. Summed scores were categorized as minimal symptoms (0-4), mild symptoms (5)(6)(7)(8)(9), moderate symptoms (10)(11)(12)(13)(14) and severe symptoms (15)(16)(17)(18)(19)(20)(21). COVID-19 related anxiety was assessed using a structured questionnaire from Turkey [29].…”

“…Disruptions to antiretroviral therapy (ART) access and support due to clinic shutdowns and staff shortage also exacerbated the risk of non-adherence to care and treatment among AWHIV during this time [9]. AWHIV in sub-Sahara African (SSA) and globally are known to have poor outcomes across the HIV care continuum, including low rates of viral suppression, adherence to treatment and retention in care [10][11][12].…”

Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis

“…Studies on impact of COVID-19 among adolescents by members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) program revealed that the COVID-19 pandemic threatened the accessibility and availability of ART for adolescents [ 31 , 35 ]. The lockdowns restricted access to health care facilities for refills, clinical support such as counselling session and other social support programs [ 27 , 28 , 35 ]. Secondly, healthcare workers were re-deployed in COVID-19 program thus reducing the number of staff members resulting to under-staffing [ 27 , 29 ].…”