Short-Term Effects of the COVID-19 Pandemic on HIV Care Utilization, Service Delivery, and Continuity of HIV Antiretroviral Treatment (ART) in Haiti

Abstract

Introduction Our study describes changes in HIV care service delivery and continuity of HIV antiretroviral therapy (ART) for people living with HIV (PLHIV) during the 8 weeks before and after diagnosis of the first coronavirus disease 2019 (COVID-19) cases in Haiti on March 19, 2020. Methods Using data from 96 out of 167 health facilities offering ART services, we compared four ART program indicators: (1) count of HIV visits; (2) proportion of ART dispenses in community-based settings (DAC); (3) proportion of multi-month dispensing of ART medications > 6 months (> 6 m MMD); and (4) proportion of timely ART refills. We used uncontrolled interrupted time series (ITS) models to estimate slope and level changes in each indicator with the arrival of COVID-19. Results and Discussion From week 1 to week 16, the average number of HIV visits fell from 121.5 to 92.5 visits, the proportion of DAC rose from 22.7% to 36.7%, the proportion of > 6 m MMD rose from 29.4% to 48.4%, and the proportion of timely ART refills fell from 51.9% to 43.8%. The ITS models estimated abrupt increases of 36% in > 6 m MMD (p < 0.001) and 37% in DAC (p < 0.001) at the time of COVID-19 arrival, and no change after arrival of COVID-19. The was an abrupt decline of 18% in timely ART refills with the arrival of COVID-19 and a decline of 1% per week thereafter, both non-statistically significant changes. Conclusions The sudden changes in HIV service utilization represent dramatic adaptations needed to mitigate primary and secondary effects of the COVID-19 pandemic on PLHIV. This study underscores the urgency of optimizing ART delivery models in Haiti and beyond, in order to maintain progress toward HIV epidemic control.

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study

“…Undue expenses related to protective equipment, including face masks and sanitizers, were a burden for the people living with HIV. This finding is in agreement with previous findings in Ethiopia ( 14 ) and elsewhere in Africa, wherein sufficient money to buy protective equipment was commonly reported effects of the COVID-19 on attending HIV clinical care and treatment services ( 51 ). The city of Addis Ababa introduced innovative measures providing ART medications for 3 to 6 months to mitigate these challenges.…”

Uptake of community‐ versus clinic‐based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa

“…DSD options have been important in minimizing exposures and ensuring continuity of HIV care during Covid‐19 [ 53 , 54 ]. Mitigation efforts have led to increased eligibility, duration of ART refills and consultations, and community‐based delivery options across sub‐Saharan Africa [ 55 , 56 ].…”

COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts

“…In line with our findings, a cross-sectional survey of MSM in 20 countries from April to May 2020 found that 18% of respondents were unable to or had difficulty refilling their ART prescriptions ( Rao et al, 2021 ). In Haiti, there was an abrupt 18% decline in the proportion of ART refills that were dispensed on time corresponding to the start of the pandemic ( Celestin et al, 2021 ). The proportion of patients who don’t refill prescriptions on time represent perhaps a lower bound on the proportion of patients who have problems with adherence to ART (since these numbers exclude persons who have sufficient ART in their possession but forget to take doses as prescribed).…”