ABSTRACT
BACKGROUND: The COVID-19 pandemic triggered high mortality in the world population and resulted in impacts on health services. Services related to HIV care and prevention were discontinued and concerns about the impacts of COVID-19 on people living with HIV (PLHIV) were discussed in different countries. In this setting, the COVID-19 pandemic has provided a decrease in combination HIV prevention, which involves access and use of HIV services, including decreasing HIV pre-exposure prophylaxis (PrEP) prescriptions, post exposure prophylaxis (PeP), interruptions in HIV ongoing care of people living with HIV and access to HIV testing. The aim of this study is to assess the implications of the COVID-19 pandemic for combination HIV prevention. METHODS: A systematic review of observational studies was performed according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). Searches were conducted in PubMed, Embase, CENTRAL, Lilacs and OpenGrey, which included studies on the impacts of the COVID-19 pandemic on prevention and care services for patients living with HIV, namely: PreP, PeP, antiretroviral treatment and testing, published until October 2021. The main impacts on these services were analyzed according to the average income of the countries. Data from the included studies were independently extracted by four reviewers. For the final articles that were selected, the following data was extracted: year of publication, study design, study site, sample size, mean age of participants, type of PrEP, adaptations to services during the pandemic and country income. RESULTS: The search identified 1396 studies, of which 90 were eligible. Most studies were cross-sectional (n=30, 32.97%) and qualitative (n=33, 36.26%), mostly performed in high-income countries. USA had the largest number of studies (n=35, 38.46%). The main themes of the selected studies were related to the repercussion of the pandemic on the health of people living with HIV (n=21, 23.08 %), in the combined prevention of HIV (n=18, 19.78%), testing and use of PrEP (n=11, 12.09% -each) and adaptations in services were also reported to maintain the provision of care (n=11, 12.09%). The most used strategy for offering the service was telehealth for consultations related to the treatment and monitoring of PrEP users. The results suggest regional discrepancies and according to the average income of the countries. Low-and middle-income countries were more affected and populations were more exposed to discontinuity in treatment and access to combination HIV prevention. It was observed that qualitative studies predominantly assessed changes in HIV prevention and treatment services. CONCLUSIONS: The Covid-19 pandemic had an impact on reducing the supply of combination HIV prevention. Systems of healthcare need to adopt adaptations in the health services in order to establish effective strategies to increase testing and access to telehealth for the population living with HIV, specially in low income countries.