Experiences of participants in a decentralized antiretroviral therapy program in South Africa during the COVID-19 pandemic

Jarolimova, Jana; Yan, Joyce; Govere, Sabina; Bunda, Bridget; Wara, Nafisa J.; Bogart, Laura M.; Ngobese, Nompumelelo; Shazi, Zinhle M; Khumalo, Anele; Zionts, Dani; Thulare, Hilary; Bassett, Ingrid V.

doi:10.1080/09540121.2022.2095333

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…These findings correlate with other studies that indicated the general preservation of ART clinic visits even during the COVID-19 pandemic. 1,6,12,22 We also found VL suppression rates of more than 70% in this study population over both study periods, similar to other sub-Saharan Africa studies pre-COVID-19. 23,24 Viral Previous studies from LMICs have rarely evaluated ART treatment programmes longitudinally over the different COVID-19 waves and various national lockdown levels imposed by a national government.…”

Section: Discussionsupporting

confidence: 90%

“…These findings correlate with other studies that indicated the general preservation of ART clinic visits even during the COVID-19 pandemic. 1 , 6 , 12 , 22 We also found VL suppression rates of more than 70% in this study population over both study periods, similar to other sub-Saharan Africa studies pre-COVID-19. 23 , 24 Viral load suppressions rates in this study were maintained throughout almost two years of the COVID-19 period and a similar period preceding, indicating infants, children and adolescents have maintained adherence to ART regimens.…”

Section: Discussionsupporting

confidence: 89%

“…Pre-lockdown stocking up, multi-month prescribing and differentiated ART delivery platforms have been documented as possible reasons for the sustained care seen specifically in the ART programmes. 22 , 25 , 26 This maintenance of care contrasted sharply with decreases noted over the same time periods with general paediatric hospitalisation rates and outpatient visits. These findings add to the limited data on the impact of the COVID-19 pandemic on paediatric ART programmes that remained robust for those already on treatment.…”

Section: Discussionmentioning

confidence: 90%

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COVID-19 and HIV viral load suppression in children and adolescents in Durban, South Africa

Mathamo¹,

Naidoo²,

Dorward³

et al. 2022

Southern African Journal of HIV Medicine

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Background The coronavirus disease 2019 (COVID-19) pandemic poses challenges to paediatric and adolescent HIV treatment programme. Modelling exercises raised concerns over potential impact of disruptions. Objectives To describe the impact of the COVID-19 pandemic on viral load (VL) testing among infants, children and adolescents on antiretroviral treatment (ART) in Durban, South Africa. Method Routinely collected, aggregated data of monthly VL counts done on all those less than 19 years old from January 2018 to January 2022 was analysed. An interrupted time series analysis using a Prais-Winsten linear regression model, including terms for lockdowns and excess mortality determined VL trends. Results The unadjusted mean VL was 2166 (confidence interval [CI]: 252.2) and 2016 (CI: 241.9), P = 0.039, and percentage VL suppression rates (72.9%, CI: 2.4% vs 73.6%, CI: 1.8%) across COVID and pre-COVID periods, showing no significant difference, P = 0.262. In the interrupted time series analysis, modelled monthly VL counts did not differ significantly by lockdown level (e.g., level 5 lockdown: –210.5 VLs, 95% CI: –483.0 to +62.1, P = 0.138) or excess mortality (–0.1, 95% CI: –6.3 to 6.1, P = 0.969). A significant downward trend in VL testing over time, including during the pre-COVID-19 period (–6.6 VL per month, 95% CI: –10.4 to –2.7, P = 0.002), was identified. Conclusion Viral load suppression for children and adolescents were not negatively affected by COVID-19. A trend of decrease in VL testing predated COVID-19. What this study adds Evidence presented that HIV VL testing and suppression rates in children and adolescents in a high burden setting were sustained through the COVID pandemic.

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Section: Discussionsupporting

confidence: 90%

“…These findings correlate with other studies that indicated the general preservation of ART clinic visits even during the COVID-19 pandemic. 1 , 6 , 12 , 22 We also found VL suppression rates of more than 70% in this study population over both study periods, similar to other sub-Saharan Africa studies pre-COVID-19. 23 , 24 Viral load suppressions rates in this study were maintained throughout almost two years of the COVID-19 period and a similar period preceding, indicating infants, children and adolescents have maintained adherence to ART regimens.…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 90%

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COVID-19 and HIV viral load suppression in children and adolescents in Durban, South Africa

Mathamo¹,

Naidoo²,

Dorward³

et al. 2022

Southern African Journal of HIV Medicine

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“…A study of telephone interviews with people living with HIV in KwaZulu-Natal during COVID-19 identified new concerns about picking up ART going forward, including COVID-19 infection risk, transportation availability, safety concerns, concern or knowledge that pick-up point is closed/no staff present, long queues, delay in being attending to, transportation cost, illness in self or family, and busy with work or family. 20 In our study, self-reported daily ART dosing was high among people living with HIV before, during, and after COVID-19 lockdowns, regardless of ART refill method, but did not correlate with viral suppression. While not correlated with viral suppression in our study, medication adherence is a self-monitored task by patients which should be emphasized during HIV counseling services.…”

Section: Discussionmentioning

confidence: 48%

Estimating the Effect of COVID-19 Pandemic Restrictions on Self-reported Antiretroviral Therapy Use and Late Refill Visits Among People Living With HIV in Rural South Africa

Tseng,

Mugwanya,

Szpiro

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: People living with HIV require reliable access to and adequate supply of antiretroviral therapy (ART) for viral suppression. The Deliver Health Study, a randomized trial conducted during the COVID-19 pandemic, found that home-delivered ART significantly increased viral suppression compared to clinic-based care. The effect of changing COVID-19 alert levels on self-reported ART use has not been quantified. Setting: KwaZulu-Natal, South Africa. Methods: Adults living with HIV were followed in the Deliver Health Study during October 2019-December 2020. We used difference-in-differences (DiD) to estimate the effect of changing COVID-19 alert levels during three distinct periods on self-reported missed ART doses (missed 0 vs. 1 doses in past week) for participants receiving home-delivered vs. clinic-based refills. We additionally estimated the effect of changing COVID-19 alert levels on late clinic ART refill visits (late vs. on-time). We used relative risk regression for both binary outcomes. Results: Of 155 participants, 46% were women and median age was 36 years. The mean number of missed weekly doses was 0.11, 0, and 0.12 in the home-delivery group and 0.09, 0.08, and 0.18 in the clinic group during periods 1, 2, and 3, respectively. There were no differences in relative risk (RR) of self-reported daily ART use between refill groups when comparing across periods (DiDperiod 2 vs. 1=1.05; 95% confidence interval [CI]: 0.97, 1.13 and DiDperiod 3 vs. 2=0.99; 95% CI: 0.91, 1.08). In the clinic group, the risk of late refill visits was significantly higher during COVID-19 restrictions (vs. before alert level 5 implementation) and even after the COVID-19 alert level was downgraded to level 1 (RRperiod 2 vs. 1=1.83, 95% CI: 1.34, 2.51 and RRperiod 3 vs. 2=1.71; 95% CI: 1.43, 2.04). Conclusion: The COVID-19 pandemic did not differentially impact self-reported ART adherence by method of ART refills, but the risk of late clinic refill visits was significantly higher during COVID-19 restrictions and sustained after restrictions were loosened.

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“…The study also found that some participants had experienced disruptions to and interruptions in ART and PrEP service delivery due to travel restrictions and police roadblocks as part of COVID-19 lockdown measures. Other studies indicate that similar disruptions occurred during COVID-19 lockdowns in South Africa [39], Uganda [40] and Kenya [41][42][43]. In respect of a study in China [28] face-to-face consultations and laboratory testing have been reduced because of the COVID-19 pandemic and its impact on HIV care, and lockdown restrictions affect people's ability to access testing or collect medicine.…”

Section: Plos Onementioning

confidence: 98%

Access to HIV prevention, treatment, and care services during COVID-19 by men who have sex with men in Zimbabwe, An interpretive phenomenological analysis study

et al. 2023

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Background Key populations are disproportionately affected by the human immunodeficiency virus (HIV) but have less access to HIV prevention and treatment services. The Coronavirus disease-2019 (COVID-19) pandemic is reinforcing health inequities among vulnerable populations, including men who have sex with men (MSM). Therefore, this article presents the findings describing the experiences of MSM in accessing HIV services during COVID-19 in the second largest city of Zimbabwe. Methods An interpretative phenomenological analysis design was applied to gain some insights regarding the lived experiences of MSM in accessing HIV prevention, treatment, and care services during COVID-19 lockdowns era in Zimbabwe. Data were collected from 14 criterion purposively selected MSM using in-depth, one-on-one interviews. Data were analysed thematically guided by the interpretative phenomenological analysis framework for data analysis. Results The findings demonstrated that during the COVID -19 lockdowns in Zimbabwe, MSM faced several barriers as they tried to access HIV services. Some of the barriers included the need for travel authorisation letters and treatment interruption. The study also found that COVID-19 and related restrictive measures had psychosocial and economic effects that encompassed loss of income, intimate partner violence and psychological effects. Conclusions Limited access to healthcare services by MSM due to COVID-19 lockdown may negatively affect the viral suppression and fuel the spread of HIV, which may reverse the gains toward the control of HIV epidemic. To sustain the gains toward HIV epidemic control and to ensure continuity of treatment, particularly for members of key populations, it is critical that the health-care delivery system adjusts by taking service to the community through adopting a differentiated service delivery approach.

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Experiences of participants in a decentralized antiretroviral therapy program in South Africa during the COVID-19 pandemic

Cited by 6 publications

References 23 publications

COVID-19 and HIV viral load suppression in children and adolescents in Durban, South Africa

COVID-19 and HIV viral load suppression in children and adolescents in Durban, South Africa

Estimating the Effect of COVID-19 Pandemic Restrictions on Self-reported Antiretroviral Therapy Use and Late Refill Visits Among People Living With HIV in Rural South Africa

Access to HIV prevention, treatment, and care services during COVID-19 by men who have sex with men in Zimbabwe, An interpretive phenomenological analysis study

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