Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country

Introduction: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV. Methods: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically. Results: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children's education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients' homes. Conclusion: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.

Epidemiological estimators’ power of rating inequality in health in high-income OECD countries, 1998-2002 / Capacidad de estimadores epidemiológicos para medir disparidades en salud en países OCDE de alto ingreso, 1998-2002

Objective Examining the power (ability) of classical epidemiological estimators to rate inequality in health in univariate and composite ways. Methods Ecological study. Ratio, excess risk, attributable risk (AR) and relative difference were the estimators used for showing disparities; all of them were weighted by population size. Kappa concordance coefficient was used between weighted estimators and weighted Gini coefficients for each health outcome used. Cumulative variance at first factor in principal component analysis was used for determining the estimators’ suitability for use in a composite index. 24 high-income OECD (Organisation for Economical Cooperation and Development) countries’ data for 1998-2002 were included. Such data was obtained from OECD health data for 2004 (3rd edition). Data concerning child mortality and gross domestic product (GDP) was obtained from World Development Indicators for 2005 on CD-ROM.The main outcomes compared amongst countries were: maternal mortality, child mortality, infant mortality, low birth-weight, life-expectancy, measles’ immunisation and DTP immunisation. Results Ratio and AR ranked maternal mortality as being the condition having the most disparity; risk excess ranked vaccination programmes and relative difference ranked low birth-weight as being the worst conditions. There was concordance in the ranking of inequities amongst ratio, AR and Gini coefficients (p<0.05). Cumulative variance in the first factor was higher for ratio and AR when they were used for constructing a composite index. Conclusions Ratio and AR were better than risk excess and relative difference for measuring disparities in health and constructing composite inequity in health indexes.

Objetivo Evaluar la capacidad de la Razón (R), exceso de riesgo (ER), fracción atribuible (FA) y diferencia relativa (DR) para medir las desigualdades en salud. Metodos Estudio ecológico. Se ponderó por el tamaño de la población. La concordancia por indicador entre estimadores y coeficiente de Gini (Gini) se evaluó con coeficiente Kappa. La varianza acumulada en el primer factor (análisis de componentes principales) fue utilizada para evaluar la capacidad de los estimadores para ser utilizados en un índice compuesto. 24 Países de Alto Ingreso (según Banco Mundial) entre 1998 y 2002, fueron incluidos. Los datos se obtuvieron del OECD Health Data, 2004 y del World Development Indicators-2005. Los indicadores comparados entre los países fueron: Mortalidad materna, mortalidad en niños menores de 5 años, mortalidad infantil, bajo peso al nacer, expectativa de vida al nacer, inmunización contra sarampión y contra DTP. Resultados R y FA posicionaron la mortalidad materna como la condición de mayor disparidad, ER posicionó los programas de vacunación y DR posicionó el bajo peso al nacer como la peor condición. Hubo concordancia en el posicionamiento de las desigualdades entre R, FA y Gini (p<0.05). La varianza acumulada en el primer factor fue mayor para R y FA, cuando ellos se utilizaron para construir un indicador compuesto. Conclusiones R y la FA atribuible son mejores que el ER y la DR para medir desigualdades en salud entre países y para construir un indicador de inequidad en salud compuesto.