Access to HIV Antiretroviral Therapy among People Living with HIV in Melbourne during the COVID-19 Pandemic

Abstract

The social measures taken to control the COVID-19 pandemic can potentially disrupt the management of HIV. The objective of this study was to examine the impact of the Australian COVID-19 lockdown restrictions on access to antiretroviral therapy (ART) for people living with HIV in Melbourne. Using data from the Melbourne Sexual Health Centre (MSHC), we assessed the changes in rates of ART postal delivery, controlled viral load, and ART dispensing from 2018 to 2020. The percentage of ART delivered by postage from the MSHC pharmacy was calculated weekly. The percentage of people living with HIV with a controlled viral load (≤200 copies/mL) was calculated monthly. We calculated a yearly Medication Possession Ratio (MPR). The average percentage of HIV ART dispensed through postage for the years 2018, 2019, and 2020 was 3.7% (371/10,023), 3.6% (380/10,685), and 14% (1478/10,765), respectively (Ptrend < 0.0001). Of the 3115 people living with HIV, the average MPR for 2018, 2019, and 2020 was 1.05, 1.06, and 1.14, respectively (Ptrend = 0.28). The average percentage of people with an HIV viral load of <200 copies/mL for the years 2018, 2019, and 2020 was 97.6% (2271/2327), 98.0% (2390/2438), and 99.2% (2048/2064), respectively (Ptrend < 0.0001). This study found that the proportion of controlled viral load and access to ART of people living with HIV in Melbourne was largely unaffected by the COVID-19 lockdown restrictions. This suggests that some of the services provided by the MSHC during the pandemic, such as HIV ART postal delivery, may assist long-term HIV management.

Sustaining sexual and reproductive health through COVID-19 pandemic restrictions: qualitative interviews with Australian clinicians

“…Similar adaptations were reported to what has been already described in some studies from Australia and elsewhere, regarding the way that continuous care to people with HIV and PrEP users was sustained, and the most urgent elements of STI screening and treatment, as well as contraception and (medical) abortion, maintained. 4,[23][24][25]36,37 Although difficult to compare across settings, the work invested in adapting rapidly suggests that the impacts on sexual and reproductive healthcare services were not as dramatic in Australia as they had the potential to be, and were in many settings. 6,9,12,13,[38][39][40][41] As reported elsewhere, 42 there were anxieties expressed by our participants about the longer-term health impacts of service restrictions, although there was clear agreement that it was essential to protect access to HIV therapies, PrEP, testing and treatment of symptomatic STIs, contraception and abortion.…”

“…4 Other service changes included a reduction in the frequency of consults, and posting or emailing prescriptions and pathology request forms to patients. 25 Although these innovations supported continuity in HIV care services, 25,26 PrEP dispensing dropped during restrictions, 27 with a 33% decline observed in the week following the first lockdowns in April 2020. 28 There was also a large reduction in post-exposure prophylaxis (PEP) prescriptions and HIV tests in 2020, which did not rise again until COVID-19 cases dropped, including after restrictions had lifted.…”

A comparative study of transgender women accessing HIV testing via face-to-face and telemedicine services in Chiang Mai, Thailand during the COVID-19 pandemic and their risk of being HIV-positive

“…The potentially associated factors with P -values of less than 0.25 in the univariable analyses [ 18 ] (i.e., sex worker experience, prior experience of HIV testing, the STI result, and a history of drug abuse) were included in a multivariable analysis with backward elimination. In addition, since we hypothesized that the telemedicine service could be beneficial for recruiting more TGW for HIV testing during the COVID-19 pandemic [ 13 ], the type of HIV testing service (face-to-face or telemedicine) was also retained as an adjustment factor in the multivariable models even though it attained a P -value higher than 0.25. Subsequently, the full model for the multivariable analysis included sex worker experience, prior experience with HIV testing, the result of STI testing, a history of drug abuse, and the HIV testing service (face-to-face or telemedicine).…”

“…With empowerment and support, the latter has played an important role in helping to design a system for accessible medical services [ 11 ]. Therefore, online [ 12 ] and mail delivery [ 13 ] have become optional channels for reaching out to target populations for HIV testing.…”

COVID-19 in the Immunocompromised Host, Including People with Human Immunodeficiency Virus

“… 36 Increasing home postal delivery of antiretroviral therapy enabled maintenance of viral load suppression in an Australian clinic cohort. 37 …”