Stay-at-Home: The Impact of the COVID-19 Lockdown on Household Functioning and ART Adherence for People Living with HIV in Three Sub-districts of Cape Town, South Africa

Abstract

In March 2020, the South African government imposed a lockdown to control COVID-19 transmission. Lockdown may affect people living with HIV’s (PLWH) antiretroviral therapy (ART) adherence. Data from a cluster randomised control trial was collected from 152 PLWH in Cape Town sub-districts from October 2019–March 2020 when the lockdown halted collection. Subsequently, 83 PLWH were followed-up in June–July 2020. Random effects models were used to analyse: (1) changes between baseline and follow-up and (2) correlates of adherence during lockdown. At follow-up, there was an increase in the odds of being below the poverty line and the odds of experiencing violence decreased. Measures for well-being, household functioning, stigma and HIV competency improved. Violence, depression, food insecurity, and stigma were associated with poorer ART adherence; higher well-being scores were associated with better adherence. During lockdown, governments need to ensure financial support, access to (mental) health services, and services for those experiencing violence. Clinical Trial Number : Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03541-0.

The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review

“…The studies carried out among PLHIV reported alterations in ART uptake as follows: a rate of 33.7%,less-than-excellent and 1.7% under-average adherence to antiretrovirals medications [ 22 ], an increase of 7% (from 5 to 12%) in the rate of non-adherence to HIV medications [ 23 ], a 23.1% decrease in obtaining antiretroviral medication[ 24 ], a rate of 8.2% one-dose-ART-medication miss and 13.2% ART uptake avoidance [ 25 ], 5% to 26% increase in the chance of ART supply failure [ 26 ], a 36% temporary non-adherence due to inadequate ART supply [ 27 ], a 13.25% rate of running out of ART medication during pandemic [ 28 ], a 27.4% rate of missing visits for the antiretroviral stock refill [ 29 ], a 3% decrease in ART uptake [ 30 ], a 24.0% rate of missing at least one dose of HIV medications [ 31 ], and a 3.6% of ART refill failure [ 21 ]. In addition, one study conducted among providers reported a 67.25% rate of ART-application-service suspension or postponement due to the COVID-19 pandemic [ 32 ].…”

“…Many patients had missed their HIV clinical visits, recovery support meetings, follow-up tests, and counseling services. The main causes of this general decline in clinical appointments were reported as follows: inadequate transport, police abuse, insufficient transportation funds to avoid exposure to COVID-19 [ 27 ], lockdowns [ 28 ], limited access to health services, reduced income, and inability to afford traveling to the health facility, being unable to get facemask, fear of COVID-19 [ 29 ], and fear of visiting hospitals [ 30 ]. Similarly, two studies conducted among healthcare providers reported disruptions in HIV services amid the pandemic.…”

“…Two studies reported an increase in telehealth utilization as a helpful method of avoiding COVID-19 exposure [ 21 , 24 ]; while, one study reported difficulties in using telemedicine [ 22 ]. Three studies reported some forms of decrease or avoidance concerning the general healthcare during the pandemic [ 25 , 28 , 33 ]. Two studies conducted among healthcare providers reported suspension or postponement of services at HIV clinics, voluntary counseling, testing services, follow-up services, home visits, support groups, walk-in services, and the inability to a timely shift to a telehealth system [ 32 , 42 ].…”

“…Three studies reported an increase in depression, anxiety, and other mental disorders among PLWH [ 21 , 28 , 31 ] while two studies reported an interruption of therapeutic services to HIV-positive patients during the pandemic [ 22 ]. Alcohol and substance abuse were reported in one study as a disruption in substance abuse care services [ 21 ] and two studies reported increased use of recreational drugs.…”

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

“…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].…”