Contributor: It’s Important to Prioritize HIV Care During the COVID-19 Pandemic

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

People were told to stay home, and many appointments and procedures were canceled.¹ Further, those who may have received their diagnosis in the hospital could not follow up for care and receive treatment, and access to antiretroviral therapy (ART) was restricted during the pandemic, which led to decreased adherence. This, in turn, affected the HIV care continuum.¹

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

While the number of telemedicine visits has increased, gaps in care remain. The most severely impacted countries were those in Latin America, with a reported 24.3% reduction in HIV consultations.² In September 2021, the World Health Organization (WHO) released guidance on maintaining health services, including safe delivery of HIV services, noting that in the sub-Saharan African region, a 6-month interruption of ART would result in over 500,000 adult deaths from HIV and an up to a 2-fold increase in perinatal transmission of HIV.³

Accessibility to HIV treatment has advanced in the last few decades, but all barriers have not been eliminated. Obstacles, including cost and social pressures, are still present, and COVID-19 has further decreased the availability of ARTs. A 2020 survey conducted by UNAIDS and the BaiHuaLin alliance of people with HIV, with support of the Chinese National Center for AIDS/STD Control and Prevention, showed that 32.6% of people in China living with HIV were at risk for ART discontinuation and 48.6% were unsure 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 multimonth medication dispenses, extended clinic hours, mobile clinics, and televisits.²

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

Fortunately, the decreases in testing, positive tests, and numbers of people starting ART in the early months of the pandemic eventually started to reverse.⁶ Multimonth ART prescriptions became more mainstream, increasing access to medication. An abstract presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in March 2021 stated, “[People] with HIV, who are virally suppressed and stable, do not need to be coming in every month to collect their medication.”⁶ Tiffany Harris, PhD, MS, Columbia University Mailman School of Public Health, presented data at CROI from 1059 facilities in 11 countries, reporting that 51% of patients received 3 months’ medication at one time from October to December 2019, which rose to 80% from June to September 2020.⁷ The WHO also supports allowing ART dispensing for up to 6 months at a time, which would limit disruption of ART and decrease client volumes in health facilities.³

The impact of the COVID-19 pandemic reverberated worldwide, and people with HIV experienced ART discontinuation and loss of follow-up. Resuming efforts to achieve HIV treatment targets should be prioritized, and keeping up with wellness visits will become the focus for many people with chronic diseases.

References

1. Jiang H, Zhou Y, Tang W. Maintaining HIV care during the COVID-19 pandemic. Lancet HIV. 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 provision across four continents. HIV Med. 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 care models during the coronavirus disease 2019 era. Clin Infect Dis. 2022;74(9):1708-1710. doi:10.1093/cid/ciab855

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

5. Declines in routine adult and teen 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 programmes 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