Impact of the COVID-19 Pandemic on Use of HIV Care, Antiretroviral Therapy Adherence, and Viral Suppression: An Observational Cohort Study From Uganda

Wagner, Zachary; Mukasa, Barbara; Nakakande, Josephine; Stecher, Chad; Saya, Uzaib; Linnemayr, Sebastian

doi:10.1097/qai.0000000000002811

Cited by 41 publications

(51 citation statements)

References 33 publications

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“…In addition, a pre-exposure prophylaxis (PrEP) program for pregnant women in Cape Town, South Africa, reported more than 2-fold higher odds of missed antenatal care visits without changes in sexual activity since the start of lockdown measures [19]. Also fear of acquiring SARS-CoV-2 infection and increased levels of food insecurity may have contributed to reducing access to HIV clinics and ART adherence through mechanisms such as depression and competing interests [20,21]. A prospective cohort study among PLWH in the slum of Kibera (Nairobi, Kenya) reported shortage of food in the household as the predominant factor (38%) that affected the uptake of medications after the onset of pandemic [18].…”

Section: Human Immunodeficiency Virus (Hiv)mentioning

confidence: 99%

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

2022

Infez Med

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The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low-and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major dis-SUMMARY eases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COV-ID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) -including neglected diseasesand non-communicable diseases. Future research and efforts are essential to deeply assess the medium-and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.

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Section: Human Immunodeficiency Virus (Hiv)mentioning

confidence: 99%

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

2022

Infez Med

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“…This is expected especially in patients with uncontrolled HIV infection with compromised cellular and humoral immune responses [111]. Despite various challenges to HIV treatment during the COVID-19 pandemic [112], COVID-19 vaccine uptake in PLWH has been reported to be generally high [113], with age, race, injection of drugs, and geographical inaccessibility identified as factors linked with poorer uptake, especially in patients not primarily on ART or other HIV care [114]. Indeed, reduced willingness to be vaccinated or COVID-19 vaccine hesitancy has been reported in PLWH, especially in younger patients, patients who inject drugs, those of black and ethnic minority groups, and gender diverse individuals [114,115].…”

Section: Discussionmentioning

confidence: 99%

HIV infection and the implication for COVID‐19 vaccination

Oyelade

Raya

Latief

2022

Public Health Challenges

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Human immunodeficiency virus (HIV) is associated with altered cellular and humoral immune response, especially in patients with an untreated or chronic infection. This may be due to direct and/or indirect HIV viral activities resulting in T‐ and B‐cells dysfunctions. Although still unclear, various studies have proposed that HIV infection may exacerbate the clinical outcomes of COVID‐19. Indeed, COVID‐19 vaccines were developed in record time and have been shown to reduce the severity of COVID‐19 in the general population. These vaccines were also earmarked as a solution to global disruptions caused by the COVID‐19 pandemic. HIV infection has been reported to reduce the efficacy of various other vaccines including those used against Streptococcus pneumoniae, Clostridium tetani, and influenza viruses. However, current guidelines for the administration of available COVID‐19 vaccines do not account for the immune‐compromised state of people living with HIV (PLWH). We discuss here the potentials, nature, and implications of this HIV‐induced dampening of the humoral immune response on COVID‐19 vaccines by first reviewing the literature about efficacy of previous vaccines in PLWH, and then assessing the proportion of PLWH included in phase III clinical trials of the COVID‐19 vaccines currently available. The clinical and public health implications as well as suggestions for governments and non‐governmental organizations are also proposed in the context of whether findings on the safety and efficacy of the vaccines could be extended to PLWH. Impacts The human immunodeficiency virus (HIV) is characterized by attenuated humoral immunity that may reduce the efficacy of vaccines in people living with HIV (PLWH). Vaccination against the SARS‐CoV‐2 infection remains the main public health answer to the COVID‐19 pandemic. Although no significant safety concerns have been raised regarding the COVID‐19 vaccines in PLWH, the efficacy of these vaccines in PLWH has not received due attention. Indeed, phase III clinical trials for the safety and efficacy of COVID‐19 vaccines involved a significantly low number of PLWH. There are major gaps in knowledge on the efficacy of COVID‐19 vaccines in PLWH and until further research is carried out, PLWH should be prioritized along with other at‐risk groups for repeated vaccination and safeguard.

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“…First, it remains a public health priority to ensure all PWH are on suppressive ART, as suboptimal HIV control is a key correlate of SARS-CoV-2 mortality and determinant of prolonged infection with the risk of accumulation of mutations [13,14]. This is especially important considering the insults to routine health services, including HIV services, during the COVID-19 pandemic [22][23][24]. Concerningly, we found an increasing and high proportion of patients with CD4 <200 cells/µL and VL ≥1000 copies/ml, possibly reflecting gaps in HIV care earlier in the pandemic.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

Kassanjee

Davies

Ngwenya

et al. 2022

Preprint

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Introduction: While a large proportion of people with HIV (PWH) have experienced SARS-CoV-2 infections, there is uncertainty about the role of HIV disease severity on COVID-19 outcomes, especially in lower income settings. We studied the association between mortality and characteristics of HIV severity and management, and vaccination, among adult PWH. Methods: We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS-CoV-2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with CD4 cell count, viral load, evidence of ART, time since first HIV evidence, and vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results: Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17 831 first diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load (among those with ART evidence), and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis, chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions: Mortality was strongly associated with suboptimal HIV control, and prevalence of these risk factors increased in later COVID-19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimised.

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Impact of the COVID-19 Pandemic on Use of HIV Care, Antiretroviral Therapy Adherence, and Viral Suppression: An Observational Cohort Study From Uganda

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 41 publications

References 33 publications

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

HIV infection and the implication for COVID‐19 vaccination

COVID-19 among adults living with HIV: Correlates of mortality in a general population in a resource-limited setting

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