The Impact of COVID-19 Lockdown on Cases of and Deaths From AIDS, Gonorrhea, Syphilis, Hepatitis B, and Hepatitis C: Interrupted Time Series Analysis

Wu, Xinsheng; Zhou, Xinyi; Chen, Yuanyi; Zhai, Ke; Sun, Ruoyao; Luo, Ganfeng; Lin, Yifan; Li, Yuwei; Yang, Chongguang; Zou, Huachun

doi:10.2196/40591

Cited by 10 publications

(6 citation statements)

References 51 publications

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“…To do this, monthly HIV/AIDS case numbers and continuous indices on COVID-19-related policy (the Oxford COVID-19 Government Response Tracker, OxCGRT) from public databases were collected to construct the SARIMA model. Comparing with a similar ITS, 14 the current study estimated the impact of COVID-19 policies on HIV/AIDS identification precisely and continuously, to evaluate its effect on case numbers. The findings from this study suggest a definite impact of COVID-19 policies on HIV/AIDS underreporting and suggest stakeholders to balance the allocation of HIV resources and with future policies to minimize future impact.…”

Section: Introductionmentioning

confidence: 99%

The influence of the COVID-19 pandemic on identifying HIV/AIDS cases in China: an interrupted time series study

Zhao¹,

Liu²,

Bulloch³

et al. 2023

The Lancet Regional Health - Western Pacific

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Section: Introductionmentioning

confidence: 99%

The influence of the COVID-19 pandemic on identifying HIV/AIDS cases in China: an interrupted time series study

Zhao¹,

Liu²,

Bulloch³

et al. 2023

The Lancet Regional Health - Western Pacific

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“…Finally, our study period may be relatively short to fully capture the outcomes among PLHIV. However, given the implementation of the treat-all policy in China in 2016, and the significant impact of COVID-19 pandemic on the HIV care continuum in 2020 52 , 53 , we had to limit the study duration to these three years. Additional long-term research is needed to further elucidate this topic after the lifting of zero-COVID policy in December 2022 in China.…”

Section: Discussionmentioning

confidence: 99%

Associations of modern initial antiretroviral therapy regimens with all-cause mortality in people living with HIV in resource-limited settings: a retrospective multicenter cohort study in China

Wu,

et al. 2023

Nat Commun

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Despite the proven virological advantages, there remains some controversy regarding whether first-line integrase strand transfer inhibitors (INSTIs)-based antiretroviral therapy (ART) contributes to reducing mortality of people living with HIV (PLHIV) in clinical practice. Here we report a retrospective study comparing all-cause mortality among PLHIV in China who were on different initial ART regimens (nevirapine, efavirenz, dolutegravir, lopinavir, and others [including darunavir, raltegravie, elvitegravir and rilpivirine]) between 2017 and 2019. A total of 41,018 individuals were included across China, representing 21.3% of newly reported HIV/AIDS cases collectively in the country during this period. Only the differences in all-cause mortality of PLHIV between the efavirenz group and the nevirapine group, the dolutegravir group and the nevirapine group, and the lopinavir group and the nevirapine group, were observed in China. After stratifying the cause of mortality, we found that the differences in mortality between initial ART regimens were mainly observed in AIDS-related mortality.

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“…As a common method for studying changes in HIV-related indicators [ 10 , 23 – 25 ], interrupted time series analysis was used to assess whether exposure to the implementation of treat-all affected these outcomes. We performed Poisson or quasi-Poisson segmented regression models to estimate the immediate impact of treat-all on these outcomes, as well as their trends.…”

Section: Methodsmentioning

confidence: 99%

“…By subtracting a time period from the time variable, we were able to center time at the June 2016 (treat-all) and December 2019 in order to estimate the immediate and long-term impact. Expected level was defined as the expected numbers from the counterfactual model in December 2019 [ 23 – 25 ]. To calculate the trend (absolute) after treat-all, we added together the coefficients associated with time and the time-dummy interaction.…”

Section: Methodsmentioning

confidence: 99%

Immediate and long-term outcomes after treat-all among people living with HIV in China: an interrupted time series analysis

Wu²,

et al. 2023

Infect Dis Poverty

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Background In 2003, China implemented free antiretroviral therapy (ART) for people living with HIV (PLHIV), establishing an eligibility threshold of CD4 < 200 cells/μl. Subsequently, the entry criteria were revised in 2012 (eligibility threshold: CD4 ≤ 350 cells/μl), 2014 (CD4 ≤ 500 cells/μl), and 2016 (treat-all). However, the impact of treat-all policy on HIV care and treatment indicators in China is unknown. We aimed to elucidate the immediate and long-term impact of the implementation of treat-all policy in China. Methods Anonymized programmatic data on ART initiation and collection in PLHIV who newly started ART were retrieved between 1 January 2015 and 31 December 2019, from two provincial and municipal Centers for Disease Control and Prevention and ten major infectious disease hospitals specialized in HIV care in China. We used Poisson and quasi-Poisson segmented regression models to estimate the immediate and long-term impact of treat-all on three key indicators: monthly proportion of 30-day ART initiation, mean CD4 counts (cells/μl) at ART initiation, and mean estimated time from infection to diagnosis (year). We built separate models according to gender, age, route of transmission and region. Results Monthly data on ART initiation and collection were available for 75,516 individuals [gender: 83.8% males; age: median 39 years, interquartile range (IQR): 28–53; region: 18.5% Northern China, 10.9% Northeastern China, 17.5% Southern China, 49.2% Southwestern China]. In the first month of treat-all, compared with the contemporaneous counterfactual, there was a significant increase in proportion of 30-day ART initiation [+ 12.6%, incidence rate ratio (IRR) = 1.126, 95% CI: 1.033–1.229; P = 0.007] and mean estimated time from infection to diagnosis (+ 7.0%, IRR = 1.070, 95% CI: 1.021–1.120; P = 0.004), while there was no significant change in mean CD4 at ART initiation (IRR = 0.990, 95% CI: 0.956–1.026; P = 0.585). By December 2019, the three outcomes were not significantly different from expected levels. In the stratified analysis, compared with the contemporaneous counterfactual, mean CD4 at ART initiation showed significant increases in Northern China (+ 3.3%, IRR = 1.033, 95% CI: 1.001–1.065; P = 0.041) and Northeastern China (+ 8.0%, IRR = 1.080, 95% CI: 1.003–1.164; P = 0.042) in the first month of treat-all; mean estimated time from infection to diagnosis showed significant increases in male (+ 5.6%, IRR = 1.056, 95% CI: 1.010–1.104; P = 0.016), female (+ 14.8%, IRR = 1.148, 95% CI: 1.062–1.240; P < 0.001), aged 26–35 (+ 5.3%, IRR = 1.053, 95% CI: 1.001–1.109; P = 0.048) and > 50 (+ 7.8%, IRR = 1.078, 95% CI: 1.000–1.161; P = 0.046), heterosexual transmission (+ 12.4%, IRR = 1.124, 95% CI: 1.042–1.213; P = 0.002) and Southwestern China (+ 12.9%, IRR = 1.129, 95% CI: 1.055–1.208; P < 0.001) in the first month of treat-all. Conclusions The implementation of treat-all policy in China was associated with a positive effect on HIV care and treatment outcomes. To advance the work of rapid ART, efforts should be made to streamline the testing and ART initiation process, provide comprehensive support services, and address the issue of uneven distribution of medical resources.

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The Impact of COVID-19 Lockdown on Cases of and Deaths From AIDS, Gonorrhea, Syphilis, Hepatitis B, and Hepatitis C: Interrupted Time Series Analysis

Cited by 10 publications

References 51 publications

The influence of the COVID-19 pandemic on identifying HIV/AIDS cases in China: an interrupted time series study

The influence of the COVID-19 pandemic on identifying HIV/AIDS cases in China: an interrupted time series study

Associations of modern initial antiretroviral therapy regimens with all-cause mortality in people living with HIV in resource-limited settings: a retrospective multicenter cohort study in China

Immediate and long-term outcomes after treat-all among people living with HIV in China: an interrupted time series analysis

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