The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019–2021: Disparities by Age and Gender

Abstract

We evaluated COVID-19’s impact on HIV care indicators among INI/FIOCRUZ’s HIV Clinical Cohort in Rio de Janeiro, Brazil: (1) Adequate care visits: two visits ≥ 90 days apart; (2) Adequate viral load monitoring: ≥ 2 viral load results ≥ 90 days apart; (3) Consistent viral suppression: all viral loads < 40 copies/mL; and (4) ART medication possession ratio (MPR) ≥ 95%. Chi-square tests compared the fraction of participants meeting each indicator per period: pre-pandemic (3/1/2019–2/29/2020) and post-pandemic (3/1/2020–2/28/2021). Logistic regression models were used to assess disparities in adequate care visits. Among 906 participants, care visits and viral load monitoring decreased pre-pandemic to post-pandemic: 77.0–55.1% and 36.6–11.6% (both p < 0.001), respectively. The optimal MPR rate improved from 25.5 to 40.0% (p < 0.001). Post-pandemic period (aOR 0.33, CI 0.28–0.40), transgender women (aOR 0.34, CI 0.22–0.53), and those aged 18–24 years (aOR 0.67, CI 0.45–0.97) had lower odds of adequate care visits. COVID-19 disrupted care access disproportionately for transgender women and younger participants. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-023-03988-3.

Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation

“… 27 , 36 Among TGW living with HIV, studies have shown that this population has lower linkage to care, lower use of ART, and poorer adherence to clinical visits. 37 , 38 For TGW, barriers to accessing care include transphobia, stigma, socioeconomic instability, and lack of awareness of available services. 26 Importantly, recent experience at INI/Fiocruz has shown that providing a welcoming, gender-affirming environment with gender-neutral toilets and trans-affirming posters, for example, can improve outcomes for TGW.…”

“…Moreover, a recent analysis evaluating continuum of care outcomes before and during the COVID-19 pandemic showed that COVID-19 disrupted care access disproportionately for TGW. 46 HIV services for TGW in Brazil should emphasize gender-affirmative care, promote autonomy, and include population-specific peer programming. 47 INI/Fiocruz has actively addressed barriers to engagement in care among TGW by enabling the establishment of Transcendendo , the first trans-specific cohort in a low- or middle-income country, and facilitating the inclusion of TGW in research studies.…”

Frailty and health-related quality of life among older people living with HIV pre- and post-COVID-19 pandemic onset: A cross-sectional study

“…The INI-Fiocruz cohort is a longitudinal observational clinical cohort with PWH receiving HIV care since 1986, as described elsewhere. 13 , 14 , 15 , 16 For this study, inclusion criteria were: (1) Age 50-years or older at the day of assessment, (2) Confirmed HIV infection, (3) Currently using antiretroviral therapy. Exclusion criteria were: (1) Participants with Parkinson disease; (2) MINI-Mental State Examination (MMSE) score <18 points; (3) Any clinical condition that impaired participation and compliance with study procedures.…”

“… 13 Moreover, the COVID-19 pandemic disrupted access to the HIV care continuum for PWH in this cohort, such as adequate care visits, viral load monitoring, and optimal medication possession ratio. 14 …”

Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil

“…Despite the country's longstanding commitment to universal access to antiretroviral therapy (ART), structural barriers remain, resulting in a high prevalence of HIV late presentation to care and poor ART adherence. These aspects have worsened after the COVID-19 pandemic and contributed to the high mpox burden [24][25][26].…”