Decrease in New Diagnosis of HIV/AIDS in the Two Years Period 2019-2020: Impact of COVID-19 Pandemic

Quiros-Roldan, Eugenia; Izzo, Ilaria; Carriero, Canio; Antoni, Melania Degli; Storti, Samuele; Tiecco, G.; Giannotti, G.; Focà, Emanuele; Castelli, Francesco

doi:10.4081/jphr.2021.2256

Cited by 13 publications

(18 citation statements)

References 11 publications

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“…Due to shifting healthcare restrictions, lockdowns and travel bans worldwide, a large number of migrant populations might not have been able to reach our ED. The impact of the pandemic reducing the number of HIV diagnoses has also been reported by other groups in multiple countries [48–53]. Regarding late diagnosis and missed opportunities, data from 12 September 2018 to 11 September 2019 are unaffected by the COVID‐19 pandemic and still show a reduction in late diagnosis, mean number of previous healthcare encounters and percentage of patients with at least one healthcare encounter, all of which hints favourably at the benefit of our intervention.…”

Section: Discussionsupporting

confidence: 70%

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

Pinto¹,

Gorgulho²,

Esteves³

et al. 2022

HIV Medicine

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Introduction: Late HIV diagnosis is associated with increased morbidity, mortality and risk of onward transmission. Increasing HIV early diagnosis is still a priority. In this observational study with historical control, we determined the impact of an opportunistic HIV screening strategy in the reduction of late diagnosis and missed opportunities for earlier diagnosis. Methods: The screening programme was implemented in the emergency department (ED) of the Hospital de Cascais between September 2018 and September 2021. Eligible patients were aged 18-64 years, with no known HIV diagnosis or antibody testing performed in the previous year, and who required blood work for any reason. Out of the 252 153 emergency visits to the ED, we identified 43 153 (17.1%) patients eligible for HIV testing. Among the total population eligible for the screening, 38 357 (88.9%) patients were ultimately tested for HIV. Impact of the ED screening was determined by analysing late diagnosis in the ED and missed opportunities at different healthcare settings 3 years before and 3 years after the start of the ED screening. Results: After 3 years of automated HIV ED testing, we found 69 newly diagnosed HIV cases (54% male, 39% Portuguese nationals, mean age 40.5 years). When comparing the characteristics of HIV diagnoses made in the ED, we observed a significant reduction in the number of people with late HIV diagnosis before and after implementation of the screening programme (78.4% vs. 39.1%, respectively; p = 0.0291). The mean number of missed opportunities for diagnosis also fell (2.6 vs. 1.5 annual encounters with the healthcare system per patient, p = 0.0997). Conclusions: People living with HIV in Cascais and their providers miss several opportunities for earlier diagnosis. Opportunistic screening strategies in settings previously deemed to be unconventional, such as EDs, are feasible and effective in mitigating missed opportunities for timely HIV diagnosis.Inês Vaz-Pinto and Ana Gorgulho contributed equally to this work.

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Section: Discussionsupporting

confidence: 70%

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

Pinto¹,

Gorgulho²,

Esteves³

et al. 2022

HIV Medicine

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“…With data from 225 HIV treatment sites across 42 countries at the end of the first year of the COVID-19 pandemic, this study found that most had experienced disruptions in clinic operations and in the provision of HIV care. Such disruptions were reported by sites across high-, medium-and low-HIV prevalence settings and country income levels, reinforcing concerns raised by modelling studies [9,[11][12][13] and observational research [41][42][43][44][45][46][47][48][49] about the potential of COVID-19 to reverse progress towards 95-95-95 UNAIDS targets to end the HIV epidemic, particularly in settings with a high HIV burden [50].…”

Section: Discussionmentioning

confidence: 99%

“…While clinics in high-prevalence settings were less http://onlinelibrary.wiley.com/doi/10.1002/jia2.26036/full | https://doi.org/10.1002/jia2.26036 likely to report suspending HIV services and appointments, other care-seeking barriers (e.g. lockdown restrictions, transportation and financial barriers, and concerns about COVID-19 exposure) may have presented insurmountable obstacles for patients in these settings, and early data from diverse settings have highlighted sharp decreases in healthcare-seeking for HIV-related services early in the pandemic, including HIV prevention [49,53], diagnosis [24,41,42,[44][45][46][47][48][53][54][55] and treatment [24,43,44,53,55,56], as well as diagnostics and treatment for other infectious diseases and chronic conditions [55][56][57][58]. While some studies in sub-Saharan Africa have reported rebounds in HIV testing and ART initiation [24,59], our findings related to stockouts of second-and third-line ART regimens in high-prevalence and low/lower-income settings are concerning, as the lack of such essential medicines may result in setbacks for both HIV treatment and prevention.…”

Section: Discussionmentioning

confidence: 99%

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

Ajeh¹,

Lee

Shamu

et al. 2022

J Int AIDS Soc.

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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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“…In 2 years (March 2020 to February 2022), we could have lost around 517, 115 and 37 new diagnoses of hrHPV, HCV and HIV respectively. Several studies suggest that a decrease in the hrHPV, HCV, HIV detection after the pandemic could lead to higher cancer mortality (15,16) and a lower life expectancy for AIDS-defining conditions (17) in the following years. The delay in the HIV diagnosis is associated with non-infectious comorbidities and multimorbidity and contributes to higher total care costs (7).…”

Section: Discussionmentioning

confidence: 99%

The Negative Impact of COVID-19 in HCV, HIV, and HPV Surveillance Programs During the Different Pandemic Waves

Romero-Hernández

García

Rodríguez-Domínguez

et al. 2022

Front. Public Health

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has been a worldwide stress test for health systems. 2 years have elapsed since the description of the first cases of pneumonia of unknown origin. This study quantifies the impact of COVID-19 in the screening program of chronic viral infections such as human papillomavirus (HPV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) along the six different pandemic waves in our population. Each wave had particular epidemiological, biological, or clinical patterns.MethodsWe analyzed the number of samples for screening of these viruses from March 2020 to February 2022, the new infections detected in the pandemic period compared to the previous year, the time elapsed between diagnosis and linking to treatment and follow-up of patients, and the percentage of late HIV diagnosis. Moreover, we used the origin of the samples as a marker for quantifying the restoration of activity in primary care.ResultsDuring the first pandemic year, the number of samples received was reduced by 26.7, 22.6, and 22.5% for molecular detection of HPV or serological HCV and HIV status respectively. The highest decrease was observed during the first wave with 70, 40, and 26.7% for HPV, HCV, and HIV. As expected, new diagnoses also decreased by 35.4, 58.2, and 40.5% for HPV, HCV, and HIV respectively during the first year of the pandemic. In the second year of the pandemic, the number of samples remained below pre-pandemic period levels for HCV (−3.6%) and HIV (−9.3%) but was slightly higher for HPV (8.0%). The new diagnoses in the second year of the pandemic were −16.1, −46.8, and −18.6% for HPV, HCV, and HIV respectively.ConclusionsUndoubtedly, an important number of new HPV, HCV, and HIV infections were lost during the COVID-19 pandemic, and surveillance programs were disrupted as a consequence of collapse of the health system. It is a priority to reinforce these surveillance programs as soon as possible in order to detect undiagnosed cases before the associated morbidity-mortality increases. New pandemic waves could increase the risk of reversing the achievements made over the last few decades.

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Decrease in New Diagnosis of HIV/AIDS in the Two Years Period 2019-2020: Impact of COVID-19 Pandemic

Cited by 13 publications

References 11 publications

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

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

The Negative Impact of COVID-19 in HCV, HIV, and HPV Surveillance Programs During the Different Pandemic Waves

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