Patient and stakeholder perspectives on impacts of the COVID-19 pandemic on HIV and mental health care delivery in South Africa

Abstract

Background The COVID-19 pandemic had a global impact on health systems and the delivery of health services, including for chronic conditions such as HIV. In South Africa, impacts on HIV services have widely been quantitatively described. Across different health settings, patients have also qualitatively described numerous negative impacts to their HIV care. However, patient perspectives on COVID-19 impacts to HIV care in South Africa, the largest HIV care system in the world, have been little explored to date. Methods We conducted 29 semi-structured individual interviews with people living with HIV ( n = 24) and providers ( n = 5) in Cape Town, South Africa. Results While most patient participants reported continued access to HIV treatment during the pandemic, many described perceiving that the quality of their care declined. Increased structural barriers were described as one contributing factor to this change. Additionally, patients described that reduced privacy in clinical interactions was a key factor negatively influencing their experience of receiving care. Conclusion Findings underscore the importance of ensuring patient privacy for HIV services even during the rearrangement of services in emergencies. It is also important to continue developing models to integrate community mental health services within HIV care delivery in South Africa.

“Early in the morning, there’s tolerance and later in the day it disappears” – The intersection of resource scarcity, stress and stigma in mental health and substance use care in South Africa

“…The primary aim of the parent study was to inform the development of an intervention to help reduce MH/SU stigma among providers and improve engagement in HIV care for PWH with co-occurring MH or SU problems (Myers et al, 2024 ). The interview guide focused on stigma (primarily enacted stigma) and strategies for stigma reduction among non-specialists (Rose et al, 2023 ; Regenauer et al, in Press ). Enacted stigma can be defined as “negative attitudes expressed by members of the public that are experienced by an individual with devalued characteristics” (Molina et al, 2013 ).…”

Factors associated with ART interruption during the COVID-19 crisis in Burundi (the EPIC community-based research program)

“…The recent global health crisis due to COVID-19 disrupted HIV care systems throughout the world in many ways. For example, activities such as HIV testing 10 – 12 and community-based tracing of patients lost to follow-up 11 were suspended, healthcare workers experienced physical and psychological burnout 13 , 14 , and the level of privacy during medical consultations was greatly reduced 15 . In some contexts, continuity of HIV care was more resilient.…”