Consequences of the COVID-19 pandemic on the continuum of the care in a cohort of people living with HIV followed in a single center of Northern Italy

Abstract

Introduction: During the COVID-19 pandemic, hospitals faced increasing pressure, where people living with HIV risked to either acquire SARS-CoV-2 and to interrupt the HIV continuum of care.Methods: this is a retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of people living with HIV (PLWH) followed by the Spedali Civili of Brescia between the bimester of the COVID-19 pandemic peak and the bimester of October-November 2019. Data were retrieved from administrative files and from paper and electronic clinical charts. Categorical variables were described using frequencies and percentages, while continuous variables were described using mean, median, and interquartile range (IQR) values. Means for continuous variables were compared using Student’s t-tests and the Mann-Whitney test. Proportions for categorical variables were compared using the χ2 test.Results: As of December 31st, 2019, a total of 3875 PLWH were followed in our clinic. Mean age was 51,4 ±13 years old, where 28% were females and 18.8% non-Italian. Overall, 98.9% were on ART (n=3834), 93% were viro-suppressed. A total of 1217 and 1162 patients had their visit scheduled at our out-patient HIV clinic during the two bimesters of 2019 and 2020, respectively. Comparing the two periods, we observed a raise of missed visits from 5% to 8% (p<0.01), a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020 (p=0.01), a drop in ART dispensation and an increase of hospitalized HIV patients due to COVID-19. ART regimens including protease inhibitors (PIs) had a smaller average drop than ART not including PIs (16,6% vs 21,6%, p<0.05). Whether this may be due to the perception of a possible efficacy of PIs on COVID19 is not known. Conclusions: Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.

Brief Report: Impact of the COVID-19 Pandemic on Virological Suppression in People Living With HIV Attending a Large Italian HIV Clinic

“…Finally, in line with the findings of another Italian study, we observed a decline in the number of determination-naive PLWH; however, this trend existed before the pandemic, which may therefore not have been a causal factor. 8 On the other hand, a large study investigating the impact of lockdown on HIV care in South Africa found that there was a 47.6% reduction in HIV testing in April 2020, and a significant reduction in the number of patients starting ART although, like us, the authors did not find any significant change in the number of patients picking up their medications. 21 Given the greater consideration that needs to be given to strategies aimed at facilitating HIV testing and promptly starting ART during the pandemic, it is interesting to note that an American study has highlighted the importance of implementing HIV self-testing.…”

“…6,7 The provision of HIV services was particularly challenging in countries such as Italy, where the delivery of HIV care and ART is almost exclusively ensured by specialists working in hospital-based infectious disease clinics, many of whom had to be transferred to newly created, dedicated COVID-19 units. 8 Italy was the first European country to be hard hit by COVID-19, and the first to face the consequent severe hospital crisis. [9][10][11] The aim of this study was to evaluate the impact of COVID-19 on HIV suppression and the continuum of care among the PLWH attending a large HIV clinic in Milan, Italy.…”

Structural and Psychosocial Impacts of the COVID-19 Pandemic on HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic

“…Reduced HIV care since the pandemic among FSW living with HIV in the DR is similar to other reports among PLHIV in other countries. 7,8,26 This study found that mental health challenges were the most robust predictor of the reduced HIV care since the pandemic. Other studies reported increased stress, anxiety, and depression among PLHIV in relation to the pandemic.…”

“…Reduced HIV care since the pandemic among FSW living with HIV in the DR is similar to other reports among PLHIV in other countries. 7,8,26…”

“…5 COVID-19 has had negative impacts on HIV care among PLHIV because social disruptions have led to reduced access to regular health care and adherence to antiretroviral therapy (ART). [6][7][8] Fear of contracting COVID-19 has further affected engagement with HIV care. 9 In addition, PLHIV have reported increased mental health challenges and substance use related to the pandemic, which have been linked to poor HIV outcomes.…”