How Paediatric HIV services weathered the COVID-19 storm in Tshwane District, South Africa: A retrospective review

Abstract

Background COVID-19 and the accompanying restrictions disrupted HIV services to children living with HIV [CLHIV] across South Africa. Prior to COVID-19, updated national HIV guidelines were released and included: a] Additional HIV polymerase chain reaction [PCR] testing at six-months for infants exposed to HIV; b] Universal HIV testing at age 18-months; c] CD4 count monitoring cessation if virologically suppressed [HIV viral load [VL] <1000 copies/mL]. We describe the effects of COVID-19 on paediatric HIV services within Tshwane District, South Africa. Methods A retrospective review of National Institute for Communicable Diseases Data Warehouse and District Health Information System data was conducted for Tshwane District from April 2019 to March 2022. Pre-pandemic [2019/20] and pandemic periods [2020/21, 2021/22] were compared. Data included: Early infant Diagnosis [EID], HIV viral load [VL] and CD4 monitoring and HIV management among children [<15 years] living with HIV [CLHIV]. Results Year-on-year, HIV testing improved at 10-weeks [2019/20: 8498; 2020/21: 8657 [+2%]; 2021/22: 8919 [+3%], six-months [2019/20: 4359; 2020/21: 7992 [+83%]; 2021/22: 9178 [+15%]] and 18-months [2019/20: 11727; 2020/21: 16232 [+38%]; 2021/22: 18750 [+16%]]; birth testing decreased [2019/20: 13881; 2020/21: 14206 [+2%]; 2021/22: 13364 [‑6%]]. The HIV EID case rates were 485 [2019/20], 410 [2020/21] and 454 [2021/22], and HIV EID test positivity was 0.77-1.2%. Antiretroviral treatment initiation initially declined [2019/20: 1692; 2020/21: 1576 [‑7%]] but subsequently improved [2021/22: 1663 [+6%]]. Initial year-on-year HIV VL and CD4 testing declined; but HIV VL testing subsequently increased whilst CD4 test numbers further declined [HIV VL tests: 2019/20: 8008; 2020/21: 6976 [‑12%]; 2021/22: 7359 [+6%]] [CD4 tests: 2019/20: 2370; 2020/21: 1953 [-18%]; 2021/22: 1843 [-6%]]. The HIV VL suppression rate among CLHIV was 69-73%. The absolute number of CD4 results <200 cells/µL or <15% declined but the proportion remained constant [2019/20: 279 [13%]; 2020/21: 223 [11%]; 2021/22: 221 [12%]]. Conclusion COVID-19 initially resulted in reduced paediatric HIV services as children disengaged from care. Indicators eventually recovered to proximate pre-pandemic levels; however, compensatory increases did not occur. Some disengaged children may not have returned to care.