ABSTRACT
Background: In Yaoundé, Cameroon, coverage of HIV prevention and treatment services has increased with an estimated 50% of people living with HIV accessing antiretroviral treatment (ART) in 2018. The HIV burden remains high among key populations, despite increases in condom use and ART among men who have sex with men (MSM), female sex workers (FSW) and their clients. The COVID-19 pandemic may temporarily alter sexual behaviours and disrupt HIV services, including ART initiation and condom distribution (with reduced outreach). We explored the potential effects of these changes on the HIV epidemic among key populations in Yaoundé. Methods: We used a deterministic mathematical model of HIV transmission calibrated to local demographic, behavioural, and HIV epidemiology data. We estimated the relative difference in cumulative new HIV infections and HIVrelated deaths from 04/2020 to 03/2021 (median, 95% uncertainty interval), under scenarios assuming individual temporary 6-month reductions in HIV prevention/treatment services or changes in sexual risk behaviour in all or some risk groups compared to a base-case scenario assuming no COVID-19-related disruptions. Results: A 6-month cessation of ART initiation alongside a 50% reduction of viral suppression among ART-users for 6-month could increase annual HIV infections by 21% (18-25%) and HIV-related deaths by 9% (7-10%): half of these impacts are attributable to ART discontinuations among key populations. A 50% reduction in condom use across all partnerships would lead to 23% (15-31%) more infections overall and 36% (20-55%) more infections among key populations (Figure). Reducing condom use among key populations (initially >80% for FSW, ∼65% for MSM) to the levels of use among lower-risk populations (∼30%), would result in 14% (9-23%) more infections overall, and 20% (8-36%), 44% (26-97%), and 29% (15-56%) more infections among MSM, FSW and their clients, respectively. A 75% reduction in paid sex due to closure of sex work-associated venues would have little effect on reducing infections overall: 4% (1-8%) if currently high condom-use and ART levels among FSW are maintained. Conclusion: Temporary disruptions in condom use and ART services, especially among key populations, may have a substantial impact on HIV in Yaoundé. Ensuring access to condoms among FSW and MSM despite reduced outreach during the COVID-19 pandemic should be a priority to minimise its potential impact.
ABSTRACT
Background: During the COVID-19 pandemic, gay, bisexual and other men who have sex with men (MSM) in the United States (US) have reported similar or fewer sexual partners and reduced access to HIV testing and care. Pre-exposure prophylaxis (PrEP) use has declined. We estimated the potential impact of COVID-19 on HIV incidence and HIV-related mortality among US MSM. Methods: We used a calibrated HIV transmission model for MSM in Baltimore, Maryland, and available data on COVID-19-related disruptions (from national online surveys of US MSM and from a Boston clinic with extensive PrEP experience) to predict impacts of data-driven reductions in sexual partners (0% or 25% - based on different surveys), condom use (5%), HIV testing (20%), viral suppression (VS;10%), PrEP initiations (72%), PrEP use (9%) and ART initiations (50%), exploring different disruption durations. We estimated the median (95% credible interval) relative change in cumulative new HIV infections and HIV-related deaths among MSM over 1 and 5 years from the start of COVID- 19-related disruptions, compared with a scenario without COVID-19-related disruptions. Results: A 6-month 25% reduction in sexual partners among Baltimore MSM, without HIV service changes, could reduce new HIV infections by 12 2%(11 7,12 8%) and 3 0%(2 6,3 4%) over 1 and 5 years, respectively. In the absence of changes in sexual behaviour, the 6-month data-driven disruptions to condom use, testing, VS, PrEP initiations, PrEP use and ART initiations combined were predicted to increase new HIV infections by 10 5%(5 8,16 5%) over 1 year, and by 3 5%(2 1,5 4%) over 5 years. A 25% reduction in partnerships offsets the negative impact of these combined service disruptions on new HIV infections (overall reduction 3 9%(-1 0,7 4%) and 0 0%(-1 4,0 9%) over 1 and 5 years, respectively), but not on HIV-related deaths (corresponding increases 11 0%(6 2,17 7%), 2 6%(1 5,4 3%)). Of the different service disruptions, a 6-month 10% reduction in VS was predicted to have the greatest impact, increasing new infections by 6 4%(2 6,11 9%) and HIV-related deaths by 9 5%(5 2,15 9%) over 1 year, without changes in sexual behaviour. The predicted impacts of reductions in partnerships or VS doubled if they lasted 12 months or if disruptions were twice as large. Conclusion: Maintaining access to ART and adherence support is of the utmost importance to minimise excess HIV-related mortality due to COVID-19 restrictions in the US, even if accompanied by reductions in sexual partnerships.