Impact of COVID-19 on the Belgian HIV epidemic: slowdown of HIV transmission and testing and adaptation of care

Abstract

Background To gain insight into the impact of the COVID-19 pandemic and containment measures on the HIV epidemic and services, this study aims to describe HIV trends in 2020 and compare them with previous years. Methods Belgian national HIV surveillance data 2017–2020 were analysed for trends in HIV testing, HIV diagnoses, VL measurements, ART uptake and PrEP purchase. Descriptive statistics from 2020 are compared to annual averages from 2017 to 2019 (proportional difference, %). Results In 2020, 725 HIV infections were diagnosed in Belgium (− 21.5% compared to 2019). The decline was most pronounced during the first lockdown in April–May but also present in July–December. The number of HIV tests performed decreased by 17.6% in 2020, particularly in March–May and October–December (− 57.5% in April and -25.4% in November 2020 compared to monthly 2017–19 numbers). Diagnosis of acute HIV infections decreased by 47.1% in 2020 (n = 27) compared to 2019 (n = 51). Late HIV diagnoses decreased by 24.7% (95% CI [− 40.7%; -9.7%]) in 2020 compared to 2019. Of patients in care in 2019, 11.8% interrupted HIV care in 2020 compared to 9.1% yearly in the 3 previous years. The number of HIV patients with VL monitoring per month dropped in March–May 2020, whilst proportions of VL suppression and ART coverage remained above 86% and 98.5% respectively in 2020. PrEP purchases, number of purchasers and starters dropped during April–May 2020 (respectively − 45.7%, − 47.4%, − 77.9% in April compared to February 2020). Conclusions The significant decrease in HIV diagnoses in Belgium in 2020 coincided with the COVID-19 pandemic and following containment measures, particularly in April–May during the first lockdown. A slowdown of HIV transmission due to reduced HIV risk exposure is suggested by the halving in diagnosis of acute HIV infections in March-December 2020 compared to the previous year, and the adaptive decrease in PrEP use and PrEP initiation from April onwards. Despite a slight increase in HIV care interruptions, the indicators of quality of HIV care remained stable. Access to prevention, testing and care for all people living with HIV and at risk of acquiring HIV is a priority during and after times of pandemic.

Effects of COVID-19 measures on access to HIV/STI testing and condoms among adults in Sweden: a cross-sectional online survey

“…While our results rely on self-reported data, they are substantiated by laboratory data from Sweden, indicating a decrease in STI tests in 2020 versus 2019 of up to 25% varying by region [20]. Similar reductions occurred in HIV/STI tests in Belgium [21], France [22] and the wider european region [6].…”

Non‐adherence and non‐persistence with antiretroviral treatment in Belgium: A real‐world evaluation using a pharmacy database, 2018–2021

“…This decline could be attributed to the impact of the coronavirus (COVID-19) pandemic, which was first reported in Belgium on February 4, 2020. 28 In response to the pandemic, government health measures, such as lockdowns and transportation restrictions limited access to healthcare and services, affecting the detection of HIV cases, initiation of ART, and drug delivery. 28 Our study revealed that approximately one in three patients on ART were non-adherent over a 12-month follow-up period.…”

“…28 In response to the pandemic, government health measures, such as lockdowns and transportation restrictions limited access to healthcare and services, affecting the detection of HIV cases, initiation of ART, and drug delivery. 28 Our study revealed that approximately one in three patients on ART were non-adherent over a 12-month follow-up period. Another study that used the SMAQ and CASE questionnaire to assess adherence in 218 patients at the AIDS reference center of Ghent University Hospital in Belgium 13 found that 78.5% and 93.5% of patients adhered to ART using the SMAQ and CASE questionnaire, respectively.…”

“…However, the number of patients initiating treatment decreased in 2020 and 2021 compared with 2018 and 2019. This decline could be attributed to the impact of the coronavirus (COVID‐19) pandemic, which was first reported in Belgium on February 4, 2020 28 . In response to the pandemic, government health measures, such as lockdowns and transportation restrictions limited access to healthcare and services, affecting the detection of HIV cases, initiation of ART, and drug delivery 28 …”