It is important to prioritize HIV care during the COVID-19 pandemic

Not all barriers to HIV care and services have been removed, and these gaps in care have been exacerbated by treatment disruptions caused by the COVIDC-19 pandemic.

About 37.9 million people living with HIV are at risk of being infected with SARS-CoV-2, the virus that causes COVID-19.1 However, the COVID-19 pandemic has created setbacks for individual and public health HIV treatment goals. These delays in care have had many undesirable effects.

People have been told to stay home and many appointments and procedures have been cancelled.1 Additionally, those who could have been diagnosed in hospital have been unable to follow care and receive treatment, and access to antiretroviral therapy (ART) has been restricted during the pandemic, leading to a decreased compliance. This, in turn, affected the continuum of HIV care.1

A respective cohort study from 2022 reported that overall HIV testing between 2019 and 2020 fell by 35.4%.1 Notably, populations at the highest risk of transmission saw an overall decrease in testing of up to 58.7%. Routine HIV appointments have also been hampered by the COVID-19 pandemic, with many people living with HIV being lost to follow-up.1

Although the number of telemedicine visits has increased, gaps in care remain. The hardest hit countries are those in Latin America, with a 24.3% reduction in HIV-related consultations.2 In September 2021, the World Health Organization (WHO) released guidance on sustaining health services, including the safe delivery of HIV-related services, noting that in the sub-Saharan Africa region, a disruption 6 months of ART would result in more than 500,000 adult HIV deaths and a two-fold increase in perinatal HIV transmission.3

Accessibility to HIV treatment has progressed over the past decades, but not all barriers have been eliminated. Barriers, including costs and social pressures, are still present, and COVID-19 has further reduced the availability of ART. A 2020 survey conducted by UNAIDS and the BaiHuaLin Alliance of People Living with HIV, with support from China’s National Center for AIDS/STD Control and Prevention, showed that 32.6% of people living with HIV in China were at risk of stopping ART and 48.6% did not know how they could get ART in the future.4 These numbers were reported before the COVID-19 pandemic and have likely increased due to the pandemic. Mitigation strategies include drug distribution over several months, extended clinic hours, mobile clinics and televisits.2

Along with HIV care, many other health processes have been disrupted, including routine vaccinations. According to insurance claim statistics from a healthcare company, adults 19 and older have missed nearly 27 million vaccinations since January 2020.5

Fortunately, the decline in tests, positive tests and the number of people starting ART in the early months of the pandemic has finally started to reverse.6 Multi-monthly prescriptions for ART have become more common, increasing access to drugs. An abstract presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in March 2021 stated: “[People] HIV-positive people, who are virally suppressed and stable, do not need to come every month to pick up their medication.6 Tiffany Harris, PhD, MS, Columbia University Mailman School of Public Health, presented CROI with data from 1,059 facilities in 11 countries, reporting that 51% of patients received 3 months of medication at one time from October to December 2019 , which increased to 80% from June to September 2020.seven WHO also supports allowing ART to be dispensed for up to 6 months at a time, which would limit ART interruption and reduce the number of clients in health facilities.3

The impact of the COVID-19 pandemic has reverberated around the world, and people living with HIV have experienced ART discontinuation and loss to follow-up. Resuming efforts to meet HIV treatment goals must be a priority, and follow-up wellness visits will become the priority for many people with chronic conditions.

References

1. Jiang H, Zhou Y, Tang W. Sustaining HIV care during the COVID-19 pandemic. HIV Lancet. 2020;7(5):e308-e309. doi:10.1016/S2352-3018(20)30105-3

2. Rick F, Odoke W, van den Hombergh J, Benzaken AS, Avelino-Silva VI. Impact of coronavirus disease (COVID-19) on HIV testing and care delivery on four continents. HIV drug. 2022;23(2):169-177. doi:10.1111/hiv.13180

3. Ford N, Vitoria M, Doherty M. World Health Organization guidance to support human immunodeficiency virus models of care during the era of coronavirus disease 2019. Clin Infect Dis. 2022;74(9):1708-1710. doi:10.1093/cid/ciab855

4. UNAIDS and China are working together during the COVID-19 outbreak to ensure that people living with HIV continue to receive treatment. Press release. UNAIDS. February 19, 2020. https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/february/20200218_china_covid19

5. The decline in routine adult and adolescent vaccinations continued in 2021. Avalere Health. January 10, 2022. https://avalere.com/insights/declines-in-routine-adult-and-teen-vaccinations-continued-in-2021

6. Burki T. HIV in the age of COVID-19. Lancet Infect Dis. 2021;21(6):774-775. doi:10.1016/S1473-3099(21)00279-6

7. Peabody R, Harris T. “Resilient” HIV programs in African countries have maintained viral suppression during the COVID-19 pandemic. Aidsmap.com. March 17, 2021. https://www.aidsmap.com/news/mar-2021/resilient-hiv-programmes-african-countries-have-maintained-viral-suppression-during

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