HIV Care Disrupted by COVID-19 Pandemic

HIV care was impacted across the world during the COVID-19 crisis but clinics responded with several effective mitigation strategies to continue to care for patients, according to an original research paper published in HIV Medicine.

Investigators from Brazil conducted a retrospective cohort study that spanned 4 continents in order to determine and describe the impact of the COVID-19 pandemic on HIV testing and treatment. Additionally, the investigators aimed to describe strategies used to mitigate the impact of the pandemic on HIV care, they said. Using secondary data from the AIDS Healthcare Foundation (AHF) Global Quality Program, the investigators identified the number of HIV tests and the percentage of positive tests, the number of in-person appointments, and the number of new enrollments for HIV care. The investigators compared data from January to August 2020 to a period in 2019.

All 4 continents showed a dip in the number of HIV tests when comparing 2020 with 2019, the study authors said. The reduction ranged from 26 percent in Europe to 44 percent in Latin America and the Caribbean, they found, noting an overall reduction of 35 percent. All European countries showed a decrease in the number of tests; in Africa, all countries except Ethiopia and Mozambique showed a decrease in the number of tests, the study authors determined.

The overall increase in percentage of positive tests was about 10 percent, the study authors said, with a low point of 2 percent in Africa and 44 percent in Europe. They wrote that this suggests targeted testing strategies may have been used during the pandemic that prioritized individuals at higher risks or symptomatic individuals. The investigators also said that MSM, transgender people, migrants, sex workers, and persons who inject drugs (PWID) had reductions in the number of tests, but among inmates, there were an increase in the number of tests performed when comparing 2020 to 2019.

In-person consultations dropped in Africa and Latin America between 2020 and 2019, the study authors said (7 percent and 24 percent, respectively). But for European and Asian countries, the investigators observed a slight increase in consultations in 2020.

The study authors additionally found that African, Asian and Latin American countries had reductions in the number of new enrollments that varied between 33 and 56 percent, but European countries saw an increase in 2020 compared to 2019. Despite the increase in in-person consultations in the European countries between January and August, there still remained a reduction of consultations in the months of March, April, and May in Europe, according to the investigators. They noted this corresponded with the highest occurrence of COVID-19 cases and severe social distancing measures were in place at that time. A similar trend was observed in Asia and Latin America, where consultations were boosted after local, severe breakouts had passed.

Mitigation strategies to increase access to care during the pandemic were numerous, depending on the type of barrier faced. For example, when there was decreased access to clinics due to lockdown restrictions, health care providers took actions such as telephone and video conference clinical consultations, pre-packed medications, extended clinic hours, alternative drug delivery, and mobile clinics. Clinics also underwent reorganizations to help physically distance, use PPE and schedule appointments; staff who worked from home were asked to call clients and encourage attendance, too, the study authors said.

Looking at other barriers, like reduced income due to the pandemic, the study authors saw that clinics provided food and hygienic packages free for vulnerable clients. When the number of people tested for HIV was reduced, clinics encouraged HIV self-testing methods and enhanced testing strategies for key populations. When it was clear that they were facing a lower retention in care, the study authors observed that clinics expanded hours, implemented video and telephone consults, and personnel encouraged continuation and resumption of care.

“The negative impact of COVID-19 on HIV care could have been even worse if client-centered strategies prioritized by AHF had not been used,” the study authors concluded. “Restrictions caused by COVID-19 accelerated innovations in HIV care services such as HIV self-testing, multiple months’ dispensation of antiretrovirals, community-led services, and alternative drug delivery. Such innovations proved to be essential, yet insufficient to mitigate the detrimental effect of the ongoing pandemic.”