ABSTRACT
Background: Progress towards the 90-90-90 HIV goals is slower for children, adolescents and youth ≤19 years (CAY) living with HIV, with only 71% of those knowing their status linked to sustained ART in the BroadReach supported districts. From the start of COVID-19 pandemic and lockdown, facility headcounts declined. We reviewed trends in CAY ART initiation and retention to evaluate effects of COVID-19 and lockdown on the already struggling CAY ART programme. Methods: Retrospective data from October 2019 to June 2021 for CAY was analyzed. October 2019 to March 2020 data was categorised as pre-COVID and April 2020 to June 2021 as COVID-era. Indicators evaluated were ART initiations, remaining in care, lost to follow-up (LTFU) and returned to care. We analyzed trends disaggregated into age bands: <5, 5-9, 10-14 and 15-19 years. Results: The quarterly ART initiation average was 1302 pre-COVID and 826 in COVID-era, (37% drop) with ages 5-9 and 10-14 years most affected (57% and 55% drop respectively). Pre-COVID CAY on ART growth was 10% (2% quarterly average). COVID-19 restrictions resulted in 8% decline in CAY on ART from 27640 to 25550 from January 2020 to June 2021. Ages 5-9 and 10-14 years had the largest attrition of-698 (15%) and-1209 (14%) respectively, with <5 years dropping by 16% (-326). However, ages 15-19 showed a gain of 143 adolescents (1% growth). Majority (66%) of CAY not in care were LTFU after being on ART >3 months, mostly noted from July to December 2020 (78%) with ages 5-9 and 10-14 years most affected (82% and 86% respectively). During more restrictive lockdown levels (April to June 2020), 4.4% CAY on ART were lost in one quarter vs 3.4% lost in the next 12 months (July 2020 to June 2021) of less restrictive levels;an average reduction of 0.85% per quarter. Intense tracing from May 2020 resulted in >94% CAY resuming treatment after more than a month of interruption vs the 17% resumption to interruption ratio seen in the 2 quarters prior. Conclusion: COVID-19 pandemic and lockdown restrictions impacted negatively on an already poorly performing CAY ART program by reducing initiations and reversing gains made in retention. The worst affected age band was 5-14-year-olds which already had the largest performance gaps prior to the COVID-19 pandemic. As we continue to trace CAY back to care, we need to upscale interventions aimed at retention in care i.e., multi-month scripting and dispensing, HIV disclosure, community and differentiated ART delivery especially for the 5-14-year-olds.