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1.
JMIR Public Health Surveill ; 2022 Apr 27.
Article in English | MEDLINE | ID: covidwho-1834202

ABSTRACT

BACKGROUND: The novel coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) threatens to disrupt global progress towards HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. OBJECTIVE: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. We describe adaptations that could address potential COVID-19-related service interruptions. METHODS: We conducted a systematic review and searched six databases: OVID/Medline, Scopus, Cochrane Library, CINAHL, PsychInfo, and Embase for studies published between January 1, 2010, and October 26, 2021 for recent technology-based interventions for virtual service delivery. Search terms included "telemedicine, telehealth, mobile health, ehealth, mhealth, telecommunication, social media, mobile device, internet" among others. Of the 6,685 abstracts identified, 1,254 focused on HIV virtual service delivery and of those, 120 were relevant for HIV prevention efforts; 48 were pertaining to PrEP and 19 of these focused on evaluations of interventions for virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies' methodological approaches and outcomes; thus, a meta-analysis was not conducted. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. RESULTS: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone applications such as iText (50% [95%CI: 16-71%]) reduction in discontinuation of PrEP) and PrEPmate (OR=2.62. 95%CI:1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as ECHO. We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications and internet for monitoring. CONCLUSIONS: Innovations in virtual service provision of PrEP occurred before COVID-19 but have new relevance in the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long-run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible healthcare platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services and be leveraged to facilitate COVID-19 pandemic control now and for future responses.

2.
Clin Infect Dis ; 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1722266

ABSTRACT

BACKGROUND: Concerns about the effects of COVID-19 pandemic on health services span the globe. We examined its effects on HIV services in sub-Saharan Africa. METHODS: Data collected quarterly [Q1: October-December 2019; Q2: January-March 2020; Q3: April-June 2020; Q4: July-September 2020] from 1,059 health facilities in 11 countries were analyzed and categorized by stringency of pandemic measures. We conducted a difference-in-differences assessment of HIV service changes from Q1-Q2 to Q3-Q4 by stringency category (high vs. low). RESULTS: There was a 3.3% decrease in the number HIV tested from Q2-Q3 (572,845 to 553,780). The number testing HIV-positive declined by 4.9% from Q2-Q3. In Q4, the number tested increased by 10.6% (612,646) from Q3, with increase by 8.8% with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2-Q3 but increased in Q4 by 9.8%. Across all quarters, the number currently on ART increased [419,028 (Q1) to 476,010 (Q4)]. The number receiving viral load (VL) testing in the past 12 months also increased [255,290 (Q1) to 312,869 (Q4)]. No decrease was noted in VL suppression (VLS) [87.5% (Q1) to 90.1% (Q4)]. HIV testing (p<0.0001) and new ART initiations (p=0.001) were inversely associated with stringency measures. CONCLUSIONS: While initial declines were observed, rebound was brisk as the pandemic progressed, with increases noted in the number HIV tested, newly-initiated or currently on ART, VL testing, and VLS throughout the period, demonstrating substantial HIV program resilience in the face of the COVID-19 crisis.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-305391

ABSTRACT

The emergence of new SARS-CoV-2 variants across the world has raised concerns about the effectiveness of available COVID-19 vaccines that were designed against the original Wuhan (wild type) variant. Critical questions have arisen regarding: (a) the effectiveness of various vaccines in preventing infection, symptomatic disease, hospitalization, intensive care unit (ICU) admission and death and (b) the magnitude and clinical consequences of post-vaccination infections in the context of emerging variants, especially the Delta variant of SARS-Cov2. While “real world” experiences with various vaccines have been reported, few have examined comparative effectiveness of various vaccines in one population, as new SARS-CoV-2 variants have emerged. Here we present an analysis of COVID-19 related outcomes from Bahrain, a country with a total population of 1.501 million, where four vaccines were deployed (total vaccinated =1,003,960), including Astra-Zeneca (AZ/Covishield), Pfizer/BioNtech, Sinopharm and Sputnik V. By analyzing individual histories of vaccinated versus unvaccinated cases, we provide a granular description of the effectiveness of the four vaccines, disease burden in unvaccinated versus vaccinated individuals over time, and the risk of four outcomes (infections, hospitalizations, ICU admissions and deaths) due to breakthrough infections among vaccinated individuals. We conclude that the four vaccines were effective in reducing all four outcomes in vaccinated compared to unvaccinated individuals, prior to, and during the period when the Delta variant became dominant in the country (May 2021 to the present). However, after censoring early vaccine recipients of Sinopharm vaccine, compared to Pfizer/BionTech recipients, individuals vaccinated with Sinopharm had a higher risk of post-vaccination infections, hospitalizations, ICU admissions and deaths, especially in those > 50 years old. Our overall findings support the value of vaccination in preventing COVID-19 related events even with the advent of the Delta variant. These data support the urgent need to expand vaccination access around the world, and may serve to guide the choice of vaccines in the context of the Delta variant.

4.
Am J Public Health ; 112(4): 562-563, 2022 04.
Article in English | MEDLINE | ID: covidwho-1652981

Subject(s)
COVID-19 , SARS-CoV-2 , Humans
5.
J Community Health ; 47(2): 361-370, 2022 04.
Article in English | MEDLINE | ID: covidwho-1640924

ABSTRACT

To describe effects of the COVID-19 pandemic on older adults living in non-institutionalized settings in New York City (NYC) we used random digit dial sampling of landlines phones to sample then interview residents 70 years and older in NYC from December 2020-March 2021. Socio-demographic, health characteristics and effects of the COVID-19 pandemic were solicited. Of 676 respondents, the average age was 78, 60% were female, and 63% had ever been tested for SARS-CoV-2, with 12% testing positive. Sixty-three percent of respondents knew someone who had been diagnosed with COVID-19 and 51% reported knowing at least one person who had died from COVID-19. Eight percent of respondents reported sometimes or often not having enough to eat, with 31% receiving food from a food pantry program. Significantly more Latinx respondents (24%) reported a positive SARS-CoV-2 test, whereas 17% of those of another race, 8% of white, and 7% of Black respondents had a positive COVID-19 test (p < 0.01). Forty-three percent of Black and 43% of Latinx respondents reported using a food pantry during COVID-19 pandemic, compared to 35% of respondents of another race and ethnicity and 18% of whites (p < 0.01). Twenty-nine percent of Latinx respondents screened for depression compared to 15% among all other races (p = 0.04). The COVID-19 pandemic has substantial health and social effects on older New Yorkers living in community settings, and experiences differed by race and ethnicity. Beyond older adults in congregate settings, those living at home have experienced wide-ranging effects of COVID-19, necessitating tailored interventions.


Subject(s)
COVID-19 , Aged , COVID-19/epidemiology , Female , Humans , New York City/epidemiology , Pandemics , SARS-CoV-2
6.
PLoS Med ; 18(11): e1003836, 2021 11.
Article in English | MEDLINE | ID: covidwho-1592117

ABSTRACT

BACKGROUND: Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness. METHODS AND FINDINGS: We reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41-1.99], p < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16-1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20-1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05-2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03-1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response. CONCLUSIONS: Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of 'ending AIDS by 2030', while simultaneously supporting progress towards universal health coverage.


Subject(s)
HIV Infections/epidemiology , Health Services , Antiretroviral Therapy, Highly Active , Cost-Benefit Analysis , Disease-Free Survival , Geography , HIV Infections/drug therapy , HIV Infections/mortality , HIV Infections/virology , Humans , Social Stigma , Treatment Outcome
7.
SSM Qual Res Health ; 2: 100027, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1592050

ABSTRACT

Emerging evidence suggests that sex workers face unique and profound risks arising from the COVID-19 pandemic. To illuminate the pandemic's effects on sex worker health and safety and identify intervention opportunities, from May-August 2020 in-depth interviews were conducted with a purposive sample of 15 sex workers, four service providers and two individuals who were both. Sampled sex workers included eight people of color, eight cisgender women, five cisgender men, three non-binary people, and one transgender woman. Using Conservation of Resources Theory to define impacts on sex worker resources and resulting health and safety implications, a deductive thematic analysis was conducted. Seven resources were threatened due to the pandemic: work opportunity, sex work venues, social support, health services, money, food, and housing. The loss of these resources was exacerbated by stigma - notably sex work criminalization - and significantly undermined health and safety by increasing food and housing instability, increasing risks of violence, and diminishing safer sex negotiation. Six resources were activated in response: social support, digital skills, health knowledge, non-sex work employment, money, and resilience. While social support had numerous benefits, investing digital skills and non-sex work employment were generally of limited impact. The pandemic's negative health and safety effects were most profound at the intersections of race, gender, class, and migration status. These findings suggest sex workers need urgent and ongoing support, with investments in social support and sex work decriminalization likely to have the greatest effects on health and safety relative to and beyond the COVID-19 pandemic.

8.
Clin Infect Dis ; 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1522158

ABSTRACT

BACKGROUND: Concerns about the effects of COVID-19 pandemic on health services span the globe. We examined its effects on HIV services in sub-Saharan Africa. METHODS: Data collected quarterly [Q1: October-December 2019; Q2: January-March 2020; Q3: April-June 2020; Q4: July-September 2020] from 1,059 health facilities in 11 countries were analyzed and categorized by stringency of pandemic measures. We conducted a difference-in-differences assessment of HIV service changes from Q1-Q2 to Q3-Q4 by stringency category (high vs. low). RESULTS: There was a 3.3% decrease in the number HIV tested from Q2-Q3 (572,845 to 553,780). The number testing HIV-positive declined by 4.9% from Q2-Q3. In Q4, the number tested increased by 10.6% (612,646) from Q3, with increase by 8.8% with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2-Q3 but increased in Q4 by 9.8%. Across all quarters, the number currently on ART increased [419,028 (Q1) to 476,010 (Q4)]. The number receiving viral load (VL) testing in the past 12 months also increased [255,290 (Q1) to 312,869 (Q4)]. No decrease was noted in VL suppression (VLS) [87.5% (Q1) to 90.1% (Q4)]. HIV testing (p<0.0001) and new ART initiations (p=0.001) were inversely associated with stringency measures. CONCLUSIONS: While initial declines were observed, rebound was brisk as the pandemic progressed, with increases noted in the number HIV tested, newly-initiated or currently on ART, VL testing, and VLS throughout the period, demonstrating substantial HIV program resilience in the face of the COVID-19 crisis.

9.
Clin Infect Dis ; 73(Suppl 1): S42-S44, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1364772

ABSTRACT

Large public-health training events may result in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Universal SARS-CoV-2 testing during trainings for the Uganda Population-based HIV Impact Assessment identified 28 of 475 (5.9%) individuals with coronavirus disease 2019 (COVID-19) among attendees; most (89.3%) were asymptomatic. Until COVID-19 vaccine is readily available for staff and participants, effective COVID-19 mitigation measures, along with SARS-CoV-2 testing, are recommended for in-person trainings, particularly when trainees will have subsequent contact with survey participants.


Subject(s)
COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Humans , SARS-CoV-2 , Uganda
11.
Clin Infect Dis ; 73(Suppl 1): S42-S44, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1207267

ABSTRACT

Large public-health training events may result in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Universal SARS-CoV-2 testing during trainings for the Uganda Population-based HIV Impact Assessment identified 28 of 475 (5.9%) individuals with coronavirus disease 2019 (COVID-19) among attendees; most (89.3%) were asymptomatic. Until COVID-19 vaccine is readily available for staff and participants, effective COVID-19 mitigation measures, along with SARS-CoV-2 testing, are recommended for in-person trainings, particularly when trainees will have subsequent contact with survey participants.


Subject(s)
COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Humans , SARS-CoV-2 , Uganda
12.
AIDS ; 34(12): 1757-1759, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-681888
13.
Health Place ; 68: 102539, 2021 03.
Article in English | MEDLINE | ID: covidwho-1103922

ABSTRACT

We assessed the geographic variation in socio-demographics, mobility, and built environmental factors in relation to COVID-19 testing, case, and death rates in New York City (NYC). COVID-19 rates (as of June 10, 2020), relevant socio-demographic information, and built environment characteristics were aggregated by ZIP Code Tabulation Area (ZCTA). Spatially adjusted multivariable regression models were fitted to account for spatial autocorrelation. The results show that different sets of neighborhood characteristics were independently associated with COVID-19 testing, case, and death rates. For example, the proportions of Blacks and Hispanics in a ZCTA were positively associated with COVID-19 case rate. Contrary to the conventional hypothesis, neighborhoods with low-density housing experienced higher COVID-19 case rates. In addition, demographic changes (e.g. out-migration) during the pandemic may bias the estimates of COVID-19 rates. Future research should further investigate these neighborhood-level factors and their interactions over time to better understand the mechanisms by which they affect COVID-19.


Subject(s)
Built Environment , COVID-19/mortality , Socioeconomic Factors , Spatial Analysis , COVID-19/ethnology , COVID-19 Testing , Humans , New York City , Residence Characteristics
14.
AIDS Behav ; 25(5): 1323-1330, 2021 May.
Article in English | MEDLINE | ID: covidwho-1002111

ABSTRACT

The COVID-19 pandemic has had serious health, economic and psychosocial consequences. Marginalized populations including female sex workers face the stark choice of risking exposure to SARS-CoV-2 as they engage with clients or prioritizing their health at the cost of losing a primary source of income. As part of an ongoing open-label, randomized controlled trial providing daily oral pre-exposure prophylaxis and adherence support, we interviewed 193 of 200 enrolled young female sex workers (18-24 years) in Kisumu, Kenya, about COVID-19 awareness and precautions, access to health services, and sex work during Kenya's pandemic-related lockdown. Nearly all participants were aware of COVID-19 and reported taking protective measures, but only half reported concerns about acquiring SARS-CoV-2. Night curfews and bar closures adversely affected participants' sex work business, reducing the number of clients and payment amounts from clients. Nearly 15% experienced violence from a client or regular, non-paying sex partner during the lockdown period. Participants' access to healthcare services was not disrupted.


RESUMEN: La pandemia de COVID-19 puede tener graves consecuencias sanitarias, económicas y psicosociales. Poblaciones marginadas como las mujeres trabajadoras sexuales se enfrentan a la dura elección de arriesgarse a exponerse al SARS-CoV-2 mientras interactúan con los clientes o priorizar su salud a riesgo de perder su principal fuente de ingresos. Como parte de un ensayo controlado aleatorio abierto en curso que proporcionaba profilaxis pre-exposición (PrEP) oral diaria y apoyo para la adherencia, entrevistamos a 193 de 200 las mujeres trabajadoras sexuales jóvenes (de 18 a 24 años) en Kisumu, Kenia, sobre su conocimiento y precauciones frente al COVID-19, acceso a servicios de salud, y trabajo sexual durante el confinamiento por la pandemia en Kenia. Casi todas las participantes conocían el COVID-19 y reportaron que tomaron medidas de protección, pero sólo la mitad dijeron estar preocupadas por infectarse con el SARS-CoV-2. Los toques de queda nocturnos y los cierres de bares afectaron negativamente al negocio del trabajo sexual, reduciendo el número de clientes y la cantidad que recibieron de los clientes. Casi el 15% experimentó violencia por parte de un cliente o por una pareja sexual habitual que no paga durante el periodo de confinamiento. El acceso de las participantes a los servicios de salud no se vio interrumpido.


Subject(s)
COVID-19 , HIV Infections , Sex Workers , Communicable Disease Control , Female , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Kenya/epidemiology , Pandemics , SARS-CoV-2
15.
BMJ Open ; 10(12): e041995, 2020 12 22.
Article in English | MEDLINE | ID: covidwho-999259

ABSTRACT

BACKGROUND: Jordan, a Middle Eastern country, declared a state of national emergency due to COVID-19 and a strict nationwide lockdown on 17 March 2020, banning all travel and movement around the country, potentially impacting mental health. This study sought to investigate the association between mental health (eg, anxiety and depressive symptoms) and sleep health among a sample of Jordanians living through a state of COVID-19-induced nationwide lockdown. METHODS: Using Facebook, participants (n=1240) in Jordan in March 2020 were recruited and direct to a web-based survey measuring anxiety (items from General Anxiety Disorder 7-item (GAD-7) scale instrument), depressive symptoms (items from Center for Epidemiologic Studies Depression Scale), sleep health (items from the Pittsburgh Sleep Quality Index) and sociodemographic. A modified Poisson regression model with robust error variance. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated to examine how anxiety and depressive symptoms may affect different dimensions of sleep health: (1) poor sleep quality, (2) short sleep duration, (3) encountering sleep problems. RESULTS: The majority of participants reported having experienced mild (33.8%), moderate (12.9%) or severe (6.3%) levels of anxiety during lockdown, and nearly half of respondents reported depressive symptoms during lockdown. Similarly, over 60% of participants reported having experienced at least one sleep problem in the last week, and nearly half reported having had short sleep duration. Importantly, anxiety was associated with poor sleep health outcomes. For example, corresponding to the dose-response relationship between anxiety and sleep health outcomes, those reporting severe anxiety were the most likely to experience poor sleep quality (aPR =8.95; 95% CI=6.12 to 13.08), short sleep duration (aPR =2.23; 95% CI=1.91 to 2.61) and at least one problem sleep problem (aPR=1.73; 95% CI=1.54 to 1.95). Moreover, depressive symptoms were also associated with poor sleep health outcomes. As compared with scoring in the first quartile, scoring fourth quartile was associated with poor sleep quality (aPR=11.82; 95% CI=6.64 to 21.04), short sleep duration (aPR=1.87; 95% CI=1.58 to 2.22), and experiencing at least one sleep problem (aPR=1.90; 95% CI=1.66 to 2.18). CONCLUSIONS: Increased levels of anxiety and depressive symptoms can negatively influence sleep health among a sample of Jordanian adults living in a state of COVID-19-induced nationwide lockdown.


Subject(s)
Anxiety , COVID-19 , Depression , Sleep Initiation and Maintenance Disorders , Social Isolation/psychology , Adult , Anxiety/complications , Anxiety/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Communicable Disease Control/methods , Depression/complications , Depression/diagnosis , Female , Humans , Jordan/epidemiology , Male , Mental Health/trends , Online Social Networking , Prevalence , Psychological Techniques , SARS-CoV-2 , Sleep Hygiene , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/etiology , Sleep Initiation and Maintenance Disorders/psychology , Surveys and Questionnaires
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