ABSTRACT
Background: To contain the coronavirus disease 2019 (Covid-19) pandemic, non-pharmacologic interventions, including lockdown and social distancing, may have adverse impact on access to HIV testing and care. This study investigated the impact of Covid-19 on HIV testing and care at a major hospital in Taiwan in 2020-2021. Method(s): The numbers of clients seeking anonymous HIV voluntary counseling and testing were compared 2 years before (2018-2019) and 2 years after Covid-19 outbreak (2020-2021). People living with HIV (PLWH) who sought care at the hospital during 2018-2021 were included to examine the status of HIV care delivery and disposition. Result(s): The annual number of HIV screening tests performed had significantly decreased from 2507 to 2794 in 2018 and 2019, respectively, to 2161 and 1737 in 2020 and 2021, respectively. The rate of discontinuation of HIV care among PLWH was 3.7% in 2019, which remained unchanged in 2020 (3.7%) and 2021 (3.8%). The respective percentage of annual plasma HIV RNA testing <2 times increased from 8.4% to 7.8% in 2018 and 2019 to 7.0% and 10.7% in 2020 and 2021, so was that of annual syphilis testing <2 times (10.1% and 8.8%-7.9% and 12.0%). The rates of plasma HIV RNA <200 copies/ml ranged from 97.0% to 98.1% in 2018-2021. Conclusion(s): During the Covid-19 pandemic, access to HIV counseling and testing was significantly limited. While the number of HIV-related testing decreased, the impact of Covid-19 on the continuity of antiretroviral therapy and viral suppression among PLWH appeared to be minimal in Taiwan. Copyright © 2022
ABSTRACT
Background: A large-scale community COVID-19 outbreak occurred between April and August 2021 in Taiwan, where non-pharmaceutical interventions (NPIs) have been strictly implemented and COVID-19 vaccination program was not implemented until 1 March, 2021. Although COVID-19 vaccination is recommended for at-risk populations, the vaccine effectiveness in people living with HIV (PLWH) remains incompletely understood. We evaluated the effectiveness of COVID-19 vaccination among PLWH during a COVID-19 outbreak in Taiwan. Methods: From 1 March to 30 September, 2021, all adult PLWH without previous SARS-CoV-2 infection were included and advised to receive 2 doses of COVID-19 vaccine. The government-funded vaccination campaign provided different types of COVID-19 vaccine, including ChAdOx1 nCoV-19 (AZD1222), BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and MVC-COV1901 (Medigen) vaccines. The primary endpoint of this study was the vaccine effectiveness in preventing COVID-19 among PLWH, which was estimated by comparing incidence rates between the unvaccinated, partially vaccinated, and fully vaccinated groups in a dynamic cohort. Results: During the study period, 3131 PLWH were included, with 99.9% on antiretroviral therapy, 99.8% being MSM and median CD4 count of 627 cells/mm3. In the dynamic cohort, 3128 PLWH contributed 516892 person-days of follow-up (PDFU) to the unvaccinated group, 2476 PLWH contributed 139163 PDFU to the partially vaccinated group, and 236 PLWH contributed 12011 PDFU to the fully vaccinated group (Table). During the follow-up, 37 PLWH (1.2%) acquired SARS-CoV-2 infections. The incidence rate of SARS-CoV-2 infection was 6.4 per 100,000 PDFU in the unvaccinated group, which decreased to 2.9 and 0 per 100,000 PDFU in the partially and fully vaccinated groups, respectively. The adjusted incidence rate ratios were 0.47 (95% CI, 0.17-1.32) in the partially vaccinated group and <0.01 in the fully vaccinated group compared with the unvaccinated group, resulting in vaccine effectiveness rates of 53.4% and 99.9% for single-and 2-dose COVID-19 vaccination, respectively. Conclusion: COVID-19 vaccination was clinically effective among PLWH during the outbreak setting where NPIs were strictly implemented.