EFFECTS of the COVID-19 LOCKDOWN on MENTAL HEALTH CARE USE in PEOPLE LIVING with HIV

Background: Mental health complications are highly prevalent among people living with HIV. Left untreated mental health complications can negatively affect HIV treatment outcomes. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic. Lockdowns might induce or exacerbate mental health conditions and limit access to treatment. We studied the effect of the lockdown on mental health care use among HIV-positive beneficiaries of a South African private sector medical aid scheme. Methods: We performed an interrupted time series analysis using insurance claims from January 1, 2017, to June 1, 2020 of HIV-positive beneficiaries aged 18 years or older from a large private sector medical aid scheme. Weekly outpatient consultation and hospital admission rates were calculated for substance use disorders (ICD10 F10-F19), serious mental disorders (F20-F29, F31), depression (F32, F34.1, F54), anxiety (F40-F48), and any mental disorder (F00-F99). We estimated adjusted odds ratios (OR) for the effect of the lockdown on weekly hospital admission and outpatient consultation rates. Results: 61,873 adults living with HIV were followed up for a median of 151 weeks. Hospital admission rates (OR 0.38;95% CI 0.27-0.54) and outpatient consultation rates (OR 0.72;95% CI 0.64-0.82) for any mental disorder decreased substantially after the implementation of the lockdown in March 2020 and did not recover to pre-lockdown levels until June 1, 2020 (Figure). Substantial decreases were observed in hospital admissions rates for substance use disorders (OR 0.13;95% CI 0.02-0.73), depression (OR 0.30;95% CI 0.16-0.54), and serious mental disorders (OR 0.58;95%CI 0.17-2.02). Decreases in outpatient consultation rates were observed for substance use disorders (OR 0.21;95% CI 0.08-0.55), anxiety disorders (OR 0.64;95% CI 0.54-0.76), depression (OR 0.71;95% CI 0.62-0.82), and serious mental disorders (OR 0.85;95% CI 0.72-1.00). Conclusion: Reduced mental health care contact rates during the COVID-19 lockdown likely reflect a substantial unmet need for mental health services with potential long-term consequences for people living with HIV and comorbid mental health complications. Steps to ensure access and continuity of mental health services during future lockdowns should be considered.

Asymptomatic COVID-19 in South Africa - implications for the control of transmission.

Asymptomatic COVID-19 may contribute significantly to the pandemic trajectory based on global biological, epidemiological and modelling evidence. A retrospective analysis was done to determine the proportion of asymptomatic COVID-19 in the workplace during the lockdown period from 27 March to 31 May 2020. We found that nearly 45% of cases were asymptomatic at the time of the first test. This high proportion of asymptomatic COVID-19 cases has implications for interventions, such as enforcing quarantine of all close contacts of COVID-19 cases regardless of symptoms.

Le COVID-19 a symptomatique pourrait contribuer significativement à la trajectoire de la pandémie en se basant sur des preuves mondiales, biologique et épidémiologiques, et en modélisant les preuves. Une analyse rétrospective a été réalisée afin de décrire la proportion d'infections asymptomatiques de SARS-CoV-2 parmi les clusters essentiels sur les lieux de travail en Afrique du Sud où des investigations de flambée ont été réalisées durant la période de confinement très restrictive du 27 mars au 31 mai 2020. Près de 45% des cas étaient asymptomatique lors du premier test. Cette proportion élevée des cas de COVID-19 asymptomatiques a des implications en ce qui concerne les interventions nonpharmaceutique comme le renforcement de la quarantaine de tous les contacts étroits des cas de SARS-CoV-2 sans tenir compte des symptômes.

Hard choices: Ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa

Access to COVID-19 vaccines has raised concerns globally. Despite calls for solidarity and social justice during the pandemic, vaccine nationalism, stockpiling of limited vaccine supplies by high-income countries and profit-driven strategies of global pharmaceutical manufacturers have brought into sharp focus global health inequities and the plight of low- and middle-income countries (LMICs) as they wait in line for restricted tranches of vaccines. Even in high-income countries that received vaccine supplies first, vaccine roll-out globally has been fraught with logistic and ethical challenges. South Africa (SA) is no exception. Flawed global institutional strategies for vaccine distribution and delivery have undermined public procurement platforms, leaving LMICs facing disproportionate shortages necessitating strict criteria for vaccine prioritisation. In anticipation of our first consignment of vaccines, deliberations around phase 1 roll-out were intense and contentious. Although the first phase focuses on healthcare personnel (HCP), the devil is in the detail. Navigating the granularity of prioritising different categories of risk in healthcare sectors in SA is complicated by definitions of risk in personal and occupational contexts. The inequitable public-private divide that characterises the SA health system adds another layer of complexity. Unlike other therapeutic or preventive interventions that are procured independently by the private health sector, COVID-19 vaccine procurement is currently limited to the SA government only, leaving HCP in the private sector dependent on central government allocation. Fair distribution among tertiary, secondary and primary levels of care is another consideration. Taking all these complexities into account, procedural and substantive ethical principles supporting a prioritisation approach are outlined. Within the constraints of suboptimal global health governance, LMICs must optimise progressive distribution of scarce vaccines to HCP at highest risk.