ABSTRACT
Introduction: The intense pressure on the health system coupled with strict measures have interrupted ART service utility during the COVID 19 pandemic. In this study, we assessed the Utilization of ART services among People Living with HIV during the COVID-19 pandemic in Kampala District, Uganda. Method(s): We studied 9952 records of patient encounters between 24th March and 1st June 2020 from the Open Medical Records System (EMR) and obtained an analytical sample of 647 encounters for PLHIV enrolled in Kampala district;243 from the Mbuya site, 274 from Kinawataka site and 130 from Banda site. We assessed factors associated with inadequate ART utilization using the modified poison regression (generalized linear model with a poisoned family and a log link) and reported clustered robust standard errors with their corresponding Prevalence Ratios. Results and Discussion: The rate of ART utilization during the COVID-19 pandemic in the Kampala district was inadequate (14.71%). PLHIV who were in WHO clinical stage 3 had aPR=18.065, 95%CI=17.396 18.759, and P-value =0.001 as compared to those in WHO stage 1. PLHIV who were obese had aPR=1.439, 95% CI=1.103 1.879, P-value =0.007 as compared to those with normal BMI. Conclusion(s): The factors associated with inadequate ART utilization were body mass index and WHO clinical staging of the disease. This information is crucial for strengthening HIV programs and interventions in terms of access to ART services, with a focus on obese infected individuals and those with advanced HIV disease during pandemics that require lock-down measures. Copyright © 2022 Emmanuel et al.
ABSTRACT
Background/Purpose In March 2020 the World Health Organisation declared Covid-19 a global pandemic. Ireland responded by shutting all non-essential shops, businesses and schools. Our healthcare system had to adapt and rapid adaptations were made to ambulatory HIV care. Approach Records were virtually reviewed and triaged using existing electronic patient records(EPR) prior to appointments. Antiretrovirals(ARVs) were pre-prescribed and prepared by pharmacy for those anticipated to remain on the same ARVs. We determined those for whom routine phlebotomy could be diverted. We paused cervical, STI screening and vaccination programme in the initial phase, reopening in a more streamlined manner as the pandemic went out of each wave and adapting again as it went back into a new wave. We undertook a staff survey to assess their views on the new service delivery. Outcomes/Impact We conducted a survey of our staff members across all disciplines. There were 34 responses out of 53 staff members. 76.47% agreed that pre reviewing EPR was better for patient care, 88.24% believed that patient flow was improved, 76.47% believed that patients time in the department was reduced due to the virtual reviews and that covid- 19 risk was reduced. 80% of doctors felt that doing the virtual reviews was a valuable training experience. 50% believed that there was more time available to deal with complex cases. Innovation and Significance Pre prescribing medications has led to better patient flow and social distancing during clinic. Complex issues, in many cases can be addressed prior to clinic and discussed with senior providers. Stricter adherence to appointment times is more convenient for patients and staff. This system has allowed us to identify patients with complex medical needs and presented opportunity for education and training between senior and junior providers, whilst decreasing Covid-19 risk to provider and patient..