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Effects of the pandemic on HIV service provision
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Pandemic-related changes in HIV service provision are shown in Table 3. Overall, 26% of sites reported suspending HIV testing and diagnostic services, and 10% reported suspending the enrolment of new patients into HIV care. Almost half (42%) of sites reported suspending or postponing non-urgent appointments for HIV patients, primarily in settings with low HIV prevalence settings (65%) and upper-middle- and high-income countries (64%).
see more results below.
Providing early data on how COVID-19 has affected the availability of HIV services across a geographically diverse group of HIV care and treatment sites, our study complements other recent studies exploring the pandemic's impact on HIV testing, ART initiation, routine visits for HIV treatment, VL monitoring and viral suppression [24, 25, 59]-studies that found minimal changes in routine HIV care-seeking during 2020, along with rebounds following initial decreases in HIV testing and ART initiation. While the expansion of adaptive measures reported in our survey may explain these encouraging findings, our study also underscores the need for ongoing monitoring of service disruptions, as well as research to identify capacity and services-from integrated laboratory systems and telemedicine infrastructure to supply chains and community support groups-that need rebuilding and strengthening in the wake of the pandemic. Further research within and across countries is needed to assess the impact of the pandemic on clinical and programmatic outcomes among people living with and at risk for HIV and to examine the role of site-level adaptive measures, such as the use of telemedicine, multi-month dispensing of ART medications or the establishment of community-based ART pick-up points, in averting treatment interruptions and ensuring the provision of person-centred HIV care .
Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium
11 December 2022
Abstract
Introduction
Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID-19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented.
Methods
From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1-4.9% and ≥5%) and country income levels.
Results
Questions about pandemic-related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low- (n = 57), lower-middle (n = 79), upper-middle (n = 39) and high- (n = 50) income countries.
Most sites reported being subject to pandemic-related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID-19 services, record-keeping interruptions and suspension of partner support.
Almost all sites in low-prevalence and high-income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high-prevalence and lower-income settings. Few sites in high-prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi-month dispensing of ART (95%) and designating community ART pick-up points (44%).
While few sites (5%) reported stockouts of first-line ART regimens, 10-11% reported stockouts of second- and third-line regimens, respectively, primarily in high-prevalence and lower-income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings.
Conclusions
While many sites in high HIV prevalence settings and lower-income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID-19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings.
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