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Impact of COVID-19 on HIV treatment interruption in seven PEPFAR countries, April'June 2020

Title
Impact of COVID-19 on HIV treatment interruption in seven PEPFAR countries, April'June 2020
Presenter
Neha Mehta
Authors
N. Mehta * (1), A. Stewart (1), K. Fisher (1), S. Ghosh (1), L. Santos (1), P. Harvey (2), M. Li (3), S. Mazibuko (3), S. Hong (4), G. Mutandi (4), C. Nyagatare (5), M.L. Umwangange (5), E. Yoboka (6), J. Kalamya (7), S. Agolory (8), K. Mweebo (8), L. Mulenga (9), P. Nyika (10), R. Weber (10), C. Mupanguri (11), S. Patel (1), J. Aberle-Grasse (1)
Institutions
(1) Centers for Disease Control and Prevention, Atlanta, United States, (2) Centers for Disease Control and Prevention, Gaborone, Botswana, (3) Centers for Disease Control and Prevention, Mbabane, Eswatini, (4) Centers for Disease Control and Prevention, Windhoek, Namibia, (5) Centers for Disease Control and Prevention, Kigali, Rwanda, (6) Ministry of Health, Kigali, Rwanda, (7) Centers for Disease Control and Prevention, Kampala, Uganda, (8) Centers for Disease Control and Prevention, Lusaka, Zambia, (9) Ministry of Health, Lusaka, Zambia, (10) Centers for Disease Control and Prevention, Harare, Zimbabwe, (11) Ministry of Health, Harare, Zimbabwe

BACKGROUND: Modeling estimates indicated that the COVID-19 pandemic would impact access to treatment for people living with HIV due to national lockdowns, restricted mobility, and overwhelmed healthcare infrastructures. We evaluated seven U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries to determine if the COVID-19 pandemic caused interruption in HIV services.
METHODS: We reviewed quarterly program data from Centers for Disease Control and Prevention HIV treatment sites among seven PEPFAR-supported countries with mature treatment programs (>80% treatment coverage). Interruption in treatment (IIT) in the months with the most restrictive mitigation measures or lockdown (April'June 2020 [P2]) were compared with the 3-month periods before (January'March 2020 [P1]) and after (July'September 2020 [P3]). Narrative data were reviewed for context.
RESULTS: During December 2019, 1,838,396 individuals were receiving antiretroviral therapy (ART) in the seven PEPFAR-supported countries assessed. Overall, in the quarter before the lockdowns (P1 vs. P2), 23% more patients experienced IIT; in the quarter after the lockdowns (P3 vs. P2), 10% fewer patients experienced IIT (Table 1). Although results varied by country, the number of patients experiencing IIT after the lockdown was either less than that during the lockdown or remained lower than before the lockdown, with the exception of Botswana. Common themes from narratives showed that programs used alternate facility refills, multi-month dispensation, community-based ART refills, and social distancing and mitigation measures in clinics to adapt to the COVID-19 pandemic.

Table 1. Interruptions in treatment during the COVID-19 pandemic
CountryPatients Experiencing an Interruption in Treatment (IIT)*positive value indicates P1 had a greater IIT than P2*negative value indicates P2 had a greater IIT than P3
January-March 2020 (P1)April-June 2020 (P2- lockdown)July-September 2020 (P3)% change between P1 and P2:
(P1 - P2)/P2Ã?100		% change between P3 and P2:
(P3 - P2)/P2Ã?100
Total51,96642,13337,78023-10
Botswana2211,8911,113-88-41
eSwatini298181186653
Namibia2,2761,9742,047154
Rwanda5485345253-2
Uganda16,11523,04615,069-30-35
Zambia25,9689,06014,80618763
Zimbabwe6,5405,4474,03420-26

CONCLUSIONS: During the initial COVID-19 lockdowns, treatment interruptions did not increase across PEPFAR-supported countries with high ART coverage. These findings suggest the rapid adoption of innovative strategies including policies around multi-month dispensing and community ART access sustained HIV treatment during the initial months of the COVID-19 pandemic. However, further research is warranted to understand the variation in IIT among these countries.