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

Abstract

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.

Virologic Outcomes and ARV Switch Profiles 2 Years After National Rollout of Dolutegravir to Children Less Than 15 Years in Southern Mozambique

“…For instance, it was difficult to ascertain if inconsistencies or missingness were due to actual service omissions or source documentation errors, both of which may have been exacerbated as rollout occurred against the backdrop of COVID-19. 24 However, the missing data we describe were minimal for most variables (<2%). For VL, low coverage seems more indicative of service-related challenges.…”

“…Deviations from monitoring schedules may be due to persistent health system challenges, particularly for vulnerable groups like children, and pandemic-related HIV service disruptions, such as the suspension of VL blood draws and limited tracing activities for those missing appointments. 23,24 However, a pooled data analysis from 2019 to 2021 found slight increases in VL coverage and VLS accompanied by an expansion of multi-month dispensation of ART as a mitigation response to COVID-19, though the authors also suggest pediatric ART programs may have been more affected by COVID-19 than adult services. 25 Among those with VL results and ≥6 months on DTG, the VLS rate was 80% for children newly initiating DTG and 86% for those switching to DTG from another anchor drug, who comprised about 96% of the cohort.…”

Cohort profile: the Viral load Cohort North-East Lesotho (VICONEL) from 2016 to 2022 – cohort description, test volumes, predictors of viraemia, and the road ahead

“…The time between blood draw and laboratory-based testing varied greatly by year but overall decreased and stabilised from 2020 to 2022, with a median of 5 (IQR 2-7) days in 2022 (Figure 1B). While we did not specifically assess the effect of the COVID-19 pandemic on viral load testing, major disruptions in viral load testing during the pandemic as reported for other settings [19] are not immediately apparent for this cohort.…”

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

“… 4 In a global survey of HIV care sites, 76% of sites reported negative impacts on their clinic operations. 5 Key challenges highlighted in this survey included suspension or delays with HIV testing, stockout of supplies, reduced provider availability, and physical reconfiguration of clinical spaces. In South Africa, which has the largest number of people living with HIV (PWH) globally, 6 pandemic-related impacts to HIV testing and treatment are well documented.…”