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Topics in Antiviral Medicine ; 30(1 SUPPL):376, 2022.
Article in English | EMBASE | ID: covidwho-1881014


Background: Mental health complications are highly prevalent among people living with HIV. Left untreated mental health complications can negatively affect HIV treatment outcomes. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic. Lockdowns might induce or exacerbate mental health conditions and limit access to treatment. We studied the effect of the lockdown on mental health care use among HIV-positive beneficiaries of a South African private sector medical aid scheme. Methods: We performed an interrupted time series analysis using insurance claims from January 1, 2017, to June 1, 2020 of HIV-positive beneficiaries aged 18 years or older from a large private sector medical aid scheme. Weekly outpatient consultation and hospital admission rates were calculated for substance use disorders (ICD10 F10-F19), serious mental disorders (F20-F29, F31), depression (F32, F34.1, F54), anxiety (F40-F48), and any mental disorder (F00-F99). We estimated adjusted odds ratios (OR) for the effect of the lockdown on weekly hospital admission and outpatient consultation rates. Results: 61,873 adults living with HIV were followed up for a median of 151 weeks. Hospital admission rates (OR 0.38;95% CI 0.27-0.54) and outpatient consultation rates (OR 0.72;95% CI 0.64-0.82) for any mental disorder decreased substantially after the implementation of the lockdown in March 2020 and did not recover to pre-lockdown levels until June 1, 2020 (Figure). Substantial decreases were observed in hospital admissions rates for substance use disorders (OR 0.13;95% CI 0.02-0.73), depression (OR 0.30;95% CI 0.16-0.54), and serious mental disorders (OR 0.58;95%CI 0.17-2.02). Decreases in outpatient consultation rates were observed for substance use disorders (OR 0.21;95% CI 0.08-0.55), anxiety disorders (OR 0.64;95% CI 0.54-0.76), depression (OR 0.71;95% CI 0.62-0.82), and serious mental disorders (OR 0.85;95% CI 0.72-1.00). Conclusion: Reduced mental health care contact rates during the COVID-19 lockdown likely reflect a substantial unmet need for mental health services with potential long-term consequences for people living with HIV and comorbid mental health complications. Steps to ensure access and continuity of mental health services during future lockdowns should be considered.

Samj South African Medical Journal ; 110(11):1077-1080, 2020.
Article in English | Web of Science | ID: covidwho-979208


The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, the South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, in order to inform the National Department of Health COVID-19 treatment guidelines. To date, the subcommittee has reviewed 14 potential treatments, and made recommendations based on local context, feasibility, resource requirements and equity. Here we describe the rapid review and evidence-to-decision process, using remdesivir and dexamethasone as examples. Our experience is that conducting rapid reviews is a practical and efficient way to address medicine policy questions under pandemic conditions.