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

Abstract

Introduction:The COVID-19 pandemic has disrupted access to critical health services, resulting in diminished gains in HIV epidemic control. This review assesses the magnitude of the impact that the COVID-19 pandemic has had on HIV services for adolescents.Methods:PEPFAR Monitoring, Evaluation, and Reporting programmatic data were analyzed from across 16 USAID-supported adolescent care and treatment programs for fiscal year 2020 (FY20; October 2019–September 2020). Descriptive statistics were used to calculate absolute number and percent change between the pre-COVID-19 (Quarters 1–2; October 2019–March 2020) and COVID-19 periods (Quarters 3–4; April 2020–September 2020) for clinical cascade indicators. All analyses were conducted in Microsoft Excel.Results:The number of HIV tests conducted during COVID-19 decreased by 21.4% compared with pre-COVID-19, with a subsequent 28% decrease in adolescents identified living with HIV. The rate of proxy linkage to antiretroviral therapy increased between periods, from 86.9% to 90.4%. There was a 25.9% decrease in treatment initiations among adolescents during COVID-19. During FY20, viral load coverage rates for adolescents dropped from 81.6% in FY20Q1 to 76.5% in FY20Q4, whereas the rates of viral load suppression for adolescents increased from 76.1% in FY20Q1 to 80.5% in FY20Q4.Conclusion:There was a substantial decrease in case-finding, treatment initiations, and viral load coverage rates for adolescents supported in USAID/PEPFAR programs during the COVID-19 pandemic. Additional health systems adaptations and strategies are required to ensure adolescents have continued access to HIV services during pandemic disruptions.

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

“…In Tanzania, during COVID-19, the government allowed the dispensing of extra ART to minimize physical contact which likely protected against signi cant interruptions to treatment and declining rates virologic suppression as a result. Our ndings are similar to those from the Congo and other SSA countries which also showed stable or improved VLS during COVID-19 for many of the same reasons [58][59][60]. High ratings in social support, and self-management also likely contributed to the high proportion with VLS, although associations between these factors and VLS were not signi cant after adjusting for other potential confounders.…”

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

“…Community-based testing is a key pillar for reaching population groups at high risk of HIV. The systematic review on 16 PEPFAR-supported countries found a similar slight decrease from 1.9% before COVID-19 to 1.7% during COVID-19 [ 21 ]. The discontinuation of outreach and testing services in communities due to the pandemic suppressed many of the case-finding strategies for key populations.…”

“…As already highlighted in the literature, the COVID-19 pandemic had a negative indirect impact on the provision of HIV services for PLHIV in many different countries [ 20 ]. In SSA, the major impact occurred between the second and third quarter of 2020 with a reduction of 33.5% and 30.8% in number of HIV test and new ART initiations, respectively, in adolescents aged 10–19 years [ 21 ]. On the other hand, an increase from 78.5% to 80.5% in viral load suppression was observed between second and third 2020 quarters [ 21 ].…”

“…In SSA, the major impact occurred between the second and third quarter of 2020 with a reduction of 33.5% and 30.8% in number of HIV test and new ART initiations, respectively, in adolescents aged 10–19 years [ 21 ]. On the other hand, an increase from 78.5% to 80.5% in viral load suppression was observed between second and third 2020 quarters [ 21 ].…”

Health Workers’ Responses to COVID-19 Pandemic’s Impact on Service Delivery to Adolescents in HIV Treatment in Cape Town, South Africa: A Qualitative Study

“…It is reported that when compared to adults living with HIV (20 years and older) and children (under 10 years), ALHIVs experience significantly lower rates of retention, adherence, and viral suppression, as well as higher rates of interruptions to treatment [ 9 , 10 , 11 , 12 , 13 ]. In 2017, it was reported that in South Africa, 62.3% of ALHIVs knew their HIV status, 65.4% were on ART, and of these 78.1% had attained viral suppression [ 14 ].…”