ABSTRACT
Background: The COVID-19 pandemic has interrupted the implementation of many HIV prevention programs supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), especially in sub-Saharan Africa. We evaluated the effects of COVID-19 pandemic (e.g., lockdowns, lack of personal protective equipment, community fears) on efforts to reach the UNAIDS 90-90-90 targets by HIV case finding using index testing (IT) and provider-initiated testing and counseling (PITC) as well as HIV treatment initiation. Methods: We conducted a descriptive analysis using programmatic data from persons aged 15 years and older reported to PEPFAR from 11 purposefully selected countries in sub-Saharan Africa. We calculated the percentage change in reported HIV case finding indicators during the COVID period, defined as January-June 2020, as compared to the pre-COVID period, during the same time frame in the preceding year, January-June 2019. Results: Of the 11 countries, persons tested for HIV through PITC declined in seven (64%) and persons testing positive declined in 10 (91%), comparing the COVID to pre-COVID periods (see Table 1). Across all countries, total HIV testing and total number of persons testing positive by PITC decreased by 20% and 23% when comparing the COVID to the pre-COVID period, respectively. In parallel, five of the 11 countries (Cameroon, DRC, Mozambique, Nigeria, South Africa) saw an increase in both IT and HIV case finding through IT, in COVID as compared to the pre-COVID period. Across all countries, total IT increased by 13% and HIV case finding through IT increased by 17% when comparing the COVID to the pre-COVID period. The number of HIV-positive people linked to treatment decreased in seven (64%) countries during the COVID period compared to pre- COVID. Across all countries, an increase of 3% in those HIV-positive people linked to treatment. Conclusion: While testing through PITC decreased during the COVID period, testing and case finding through IT increased. The increase in IT may reflect the actions of healthcare facilities and providers to ensure that HIV-exposed individuals identified by an index case were still tested. Focusing on IT may help programs effectively identify HIV-positive people, even during a pandemic or other disturbance.