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2.
S Afr Fam Pract (2004) ; 63(1): e1-e4, 2021 09 27.
Article in English | MEDLINE | ID: covidwho-1463909

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has had an enormous impact on the provision of human immunodeficiency virus (HIV) services amongst people living with HIV. Many people have adopted different health-seeking behaviour in alignment with the lockdown provisions during the COVID-19 pandemic. These lockdown regulations have had a huge impact on healthcare access for people on chronic medication. The disruption of antiretroviral therapy (ART) has a profound effect on HIV-associated morbidity and mortality. The impact on HIV programmes as a result of the interruption in ART could be bigger than the HIV pandemic alone.


Subject(s)
Anti-HIV Agents/therapeutic use , COVID-19/complications , COVID-19/epidemiology , HIV Infections/drug therapy , Health Services Accessibility , Antiretroviral Therapy, Highly Active , COVID-19/diagnosis , COVID-19/prevention & control , Communicable Disease Control , Female , Humans , Middle Aged , Pandemics , South Africa/epidemiology
3.
J Int AIDS Soc ; 24(9): e25781, 2021 09.
Article in English | MEDLINE | ID: covidwho-1384195

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has affected antiretroviral therapy (ART) continuity among people living with HIV (PLHIV) worldwide. We conducted a qualitative study to explore barriers to ART maintenance and solutions to ART interruption when stringent COVID-19 control measures were implemented in China, from the perspective of PLHIV and relevant key stakeholders. METHODS: Between 11 February and 15 February 2020, we interviewed PLHIV, community-based organization (CBO) workers, staff from centres for disease control and prevention (CDC) at various levels whose work is relevant to HIV care (CDC staff), HIV doctors and nurses and drug vendors from various regions in China. Semi-structured interviews were conducted using a messaging and social media app. Challenges and responses relevant to ART continuity during the COVID-19 pandemic were discussed. Themes were identified by transcript coding and mindmaps. RESULTS: Sixty-four stakeholders were recruited, including 16 PLHIV, 17 CBO workers, 15 CDC staff, 14 HIV doctors and nurses and two drug vendors. Many CDC staff, HIV doctors and nurses responsible for ART delivery and HIV care were shifted to COVID-19 response efforts. Barriers to ART maintenance were (a) travel restrictions, (b) inadequate communication and bureaucratic obstacles, (c) shortage in personnel, (d) privacy concerns, and (e) insufficient ART reserve. CBO helped PLHIV maintain access to ART through five solutions identified from thematic analysis: (a) coordination to refill ART from local CDC clinics or hospitals, (b) delivery of ART by mail, (c) privacy protection measures, (d) mental health counselling, and (e) providing connections to alternative sources of ART. Drug vendors contributed to ART maintenance by selling out-of-pocket ART. CONCLUSIONS: Social and institutional disruption from COVID-19 contributed to increased risk of ART interruption among PLHIV in China. Collaboration among key stakeholders was needed to maintain access to ART, with CBO playing an important role. Other countries facing ART interruption during current or future public health emergencies may learn from the solutions employed in China.


Subject(s)
Anti-Retroviral Agents/supply & distribution , Antiretroviral Therapy, Highly Active/methods , COVID-19 , Continuity of Patient Care , HIV Infections/drug therapy , Health Services Accessibility , Adult , Anti-Retroviral Agents/administration & dosage , Anti-Retroviral Agents/therapeutic use , COVID-19/epidemiology , COVID-19/psychology , China/epidemiology , Female , HIV Infections/epidemiology , HIV Infections/psychology , Humans , Male , Pandemics , Qualitative Research , SARS-CoV-2 , Stakeholder Participation
6.
J Int AIDS Soc ; 24(8): e25741, 2021 08.
Article in English | MEDLINE | ID: covidwho-1336004

ABSTRACT

INTRODUCTION: Adolescents and young people comprise a growing proportion of new HIV infections globally, yet current approaches do not effectively engage this group, and adolescent HIV-related outcomes are the poorest among all age groups. Providing psychosocial interventions incorporating psychological, social, and/or behavioural approaches offer a potential pathway to improve engagement in care and health and behavioural outcomes among adolescents and young people living with HIV (AYPLHIV). METHODS: A systematic search of all peer-reviewed papers published between January 2000 and July 2020 was conducted through four electronic databases (Cochrane Library, PsycINFO, PubMed and Scopus). We included randomized controlled trials evaluating psychosocial interventions aimed at improving engagement in care and health and behavioural outcomes of AYPLHIV aged 10 to 24 years. RESULTS AND DISCUSSION: Thirty relevant studies were identified. Studies took place in the United States (n = 18, 60%), sub-Saharan Africa (Nigeria, South Africa, Uganda, Zambia, Zimbabwe) and Southeast Asia (Thailand). Outcomes of interest included adherence to antiretroviral therapy (ART), ART knowledge, viral load data, sexual risk behaviours, sexual risk knowledge, retention in care and linkage to care. Overall, psychosocial interventions for AYPLHIV showed important, small-to-moderate effects on adherence to ART (SMD = 0.3907, 95% CI: 0.1059 to 0.6754, 21 studies, n = 2647) and viral load (SMD = -0.2607, 95% CI -04518 to -0.0696, 12 studies, n = 1566). The psychosocial interventions reviewed did not demonstrate significant impacts on retention in care (n = 8), sexual risk behaviours and knowledge (n = 13), viral suppression (n = 4), undetectable viral load (n = 5) or linkage to care (n = 1) among AYPLHIV. No studies measured transition to adult services. Effective interventions employed various approaches, including digital and lay health worker delivery, which hold promise for scaling interventions in the context of COVID-19. CONCLUSIONS: This review highlights the potential of psychosocial interventions in improving health outcomes in AYPLHIV. However, more research needs to be conducted on interventions that can effectively reduce sexual risk behaviours of AYPLHIV, as well as those that can strengthen engagement in care. Further investment is needed to ensure that these interventions are cost-effective, sustainable and resilient in the face of resource constraints and global challenges such as the COVID-19 pandemic.


Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/psychology , Patient Participation/psychology , Psychosocial Intervention , Treatment Adherence and Compliance/psychology , Adolescent , Antiretroviral Therapy, Highly Active , COVID-19 , Female , HIV Infections/drug therapy , Humans , Male , Pandemics , Risk-Taking , SARS-CoV-2 , Sexual Behavior , South Africa , Viral Load , Young Adult
8.
Int J Gynaecol Obstet ; 154(2): 220-226, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1245424

ABSTRACT

OBJECTIVE: To explore the challenges of women taking antiretroviral treatment (ART) during the COVID-19 pandemic lockdown in a peri-urban area. METHODS: An exploratory qualitative study approach was used. Semi-structured questions were devised and used to elicit data on the impact of the COVID-19 lockdown on women accessing treatment for HIV. Twenty women were interviewed through contacts from community and faith organizations in peri-urban Harare. All interviews were audio-recorded, transcribed verbatim and entered into NVivo to make analysis easy. The data were thematically analyzed, underpinned by the four phases of data analysis in the Silences Framework. RESULTS: The study discovered that transport problems, confusing COVID-19 restrictions, abuse by police and soldiers at roadblocks, a shortage of medication, lack of health check-up routines, involuntary default of ART, and a shortage of personal protective equipment affected HIV-positive women accessing ART during the COVID-19 lockdown. CONCLUSION: People living with HIV need a robust supporting environment and a functioning health system. In response to COVID-19 all services were halted to prevent the spread of COVID-19. Pandemic preparedness is important in keeping an adequate supply of ART and responding to the needs of individuals on HIV treatment.


Subject(s)
Antiretroviral Therapy, Highly Active , COVID-19/prevention & control , HIV Infections/drug therapy , Health Services Accessibility , Adult , Anti-Retroviral Agents/therapeutic use , COVID-19/epidemiology , COVID-19/psychology , Fear , Female , HIV Infections/psychology , Humans , Male , Medication Adherence , Pandemics , SARS-CoV-2 , Zimbabwe
9.
J Med Virol ; 93(2): 726-732, 2021 02.
Article in English | MEDLINE | ID: covidwho-1196407

ABSTRACT

Since its first appearance in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world and has become a global pandemic. Several medical comorbidities have been identified as risk factors for coronavirus disease 2019 (COVID-19). However, it remains unclear whether people living with human immunodefeciency virus (PLWH) are at an increased risk of COVID-19 and severe disease manifestation, with controversial suggestion that HIV-infected individuals could be protected from severe COVID-19 by means of antiretroviral therapy or HIV-related immunosuppression. Several cases of coinfection with HIV and SARS-CoV-2 have been reported from different parts of the globe. This review seeks to provide a holistic overview of SARS-CoV-2 infection in PLWH.


Subject(s)
Anti-HIV Agents/therapeutic use , COVID-19/epidemiology , HIV Infections/epidemiology , Immunocompromised Host , Pandemics , SARS-CoV-2/pathogenicity , Adult , Antiretroviral Therapy, Highly Active/statistics & numerical data , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/virology , COVID-19/immunology , COVID-19/mortality , COVID-19/virology , Coinfection , Comorbidity , Diabetes Mellitus/epidemiology , Diabetes Mellitus/physiopathology , Female , HIV/drug effects , HIV/growth & development , HIV/pathogenicity , HIV Infections/drug therapy , HIV Infections/mortality , HIV Infections/virology , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Male , Middle Aged , SARS-CoV-2/immunology , Survival Analysis , Treatment Outcome
12.
Clin Infect Dis ; 71(16): 2294-2297, 2020 11 19.
Article in English | MEDLINE | ID: covidwho-1153179

ABSTRACT

We describe the characteristics of 31 people living with human immunodeficiency virus hospitalized for severe acute respiratory syndrome coronavirus 2 infection. All patients were on antiretroviral therapy and virologically suppressed at the time of admission. Clinical course and outcomes were similar to those reported in other hospitalized cohorts.


Subject(s)
COVID-19/mortality , COVID-19/virology , HIV Infections/complications , Hospitalization/statistics & numerical data , Registries , Adult , Aged , Aged, 80 and over , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , COVID-19/drug therapy , Cohort Studies , Female , HIV Infections/drug therapy , Humans , Immunocompromised Host , Male , Middle Aged , New York City , Radiography , SARS-CoV-2 , Sustained Virologic Response , Tertiary Care Centers , Young Adult
13.
BMJ Case Rep ; 14(3)2021 Mar 23.
Article in English | MEDLINE | ID: covidwho-1148109

ABSTRACT

A 36-year-old African American man with no medical history presented with a recent history of cough and dyspnoea. Initial chest imaging revealed diffuse bilateral lung infiltrates. A subsequent HIV test resulted positive, and he was presumptively diagnosed with AIDS, later confirmed by a CD4 of 88 cells/mm3 Empiric therapy with trimethoprim-sulfamethoxazole was initiated for presumed Pneumocystis jirovecii pneumonia. The patient's clinical status deteriorated despite treatment. Further workup with chest CT, bronchoscopy and skin biopsy led to a diagnosis of Kaposi sarcoma with pulmonary involvement. Highly active antiretroviral therapy therapy was initiated, along with plans to start chemotherapy. However, the patient's clinical status rapidly declined, leading to respiratory failure and eventual death. This case underlines the importance of maintaining a broad differential in immunocompromised patients presenting with respiratory symptoms.


Subject(s)
Acquired Immunodeficiency Syndrome , Pneumocystis carinii , Pneumonia, Pneumocystis , Sarcoma, Kaposi , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Antiretroviral Therapy, Highly Active , Humans , Male , Pneumonia, Pneumocystis/complications , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
14.
Lancet HIV ; 8(4): e206-e215, 2021 04.
Article in English | MEDLINE | ID: covidwho-1093284

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, men who have sex with men (MSM) in the USA have reported similar or fewer sexual partners and reduced HIV testing and care access compared with before the pandemic. Pre-exposure prophylaxis (PrEP) use has also declined. We aimed to quantify the potential effect of COVID-19 on HIV incidence and HIV-related mortality among US MSM. METHODS: We used a calibrated, deterministic, compartmental HIV transmission model for MSM in Baltimore (MD, USA) and available data on COVID-19-related disruptions to HIV services to predict effects of reductions in sexual partners (0%, 25%, 50%), condom use (5%), HIV testing (20%), viral suppression (10%), PrEP initiations (72%), PrEP adherence (9%), and antiretroviral therapy (ART) initiations (50%). In our main analysis, we modelled disruptions due to COVID-19 starting Jan 1, 2020, and lasting 6 months. We estimated the median change in cumulative new HIV infections and HIV-related deaths among MSM over 1 and 5 years, compared with a base case scenario without COVID-19-related disruptions. FINDINGS: A 25% reduction in sexual partners for 6 months among MSM in Baltimore, without HIV service changes, could reduce new HIV infections by median 12·2% (95% credible interval 11·7 to 12·8) over 1 year and median 3·0% (2·6 to 3·4) over 5 years. In the absence of changes in sexual behaviour, the 6-month estimated reductions in condom use, HIV testing, viral suppression, PrEP initiations, PrEP adherence, and ART initiations combined are predicted to increase new HIV infections by median 10·5% (5·8 to 16·5) over 1 year, and by median 3·5% (2·1 to 5·4) over 5 years. Disruptions to ART initiations and viral suppression are estimated to substantially increase HIV-related deaths (ART initiations by median 1·7% [0·8 to 3·2], viral suppression by median 9·5% [5·2 to 15·9]) over 1 year, with smaller proportional increases over 5 years. The other individual disruptions (to HIV testing, PrEP and condom use, PrEP initiation, and partner numbers) were estimated to have little effect on HIV-related deaths (<1% change over 1 or 5 years). A 25% reduction in sexual partnerships is estimated to offset the effect of the combined service disruptions on new HIV infections (change over 1 year: median -3·9% [-7·4 to 1·0]; over 5 years: median 0·0% [-0·9 to 1·4]), but not on HIV deaths (change over 1 year: 11·0% [6·2 to 17·7]; over 5 years: 2·6% [1·5 to 4·3]). INTERPRETATION: Maintaining access to ART and adherence support is of the utmost importance to maintain viral suppression and minimise excess HIV-related mortality due to COVID-19 restrictions in the USA, even if disruptions to services are accompanied by reductions in sexual partnerships. FUNDING: National Institutes of Health.


Subject(s)
Anti-HIV Agents/therapeutic use , COVID-19/epidemiology , Condoms/statistics & numerical data , HIV Infections/epidemiology , Models, Statistical , Pre-Exposure Prophylaxis/statistics & numerical data , Adolescent , Adult , African Americans , Antiretroviral Therapy, Highly Active , Baltimore/epidemiology , HIV Infections/ethnology , HIV Infections/mortality , HIV Infections/transmission , Health Services Accessibility/statistics & numerical data , Homosexuality, Male , Humans , Incidence , Male , Prognosis , Risk-Taking , Sexual Partners , Survival Analysis
15.
AIDS ; 34(8): F1-F2, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-1055780

ABSTRACT

: To ensure the continuity of high-quality HIV care in Kisumu County, Kenya during the corona virus disease 2019 pandemic, the Ministry of Health implemented a strategy to promote physical distancing and corona virus disease 2019 case detection. A total of 23 262 (84.2%) of the 27 641 patients eligible for early refill received an extra 3-month supply of antiretrovirals. Across 60 Ministry of Health clinics, average attendance decreased from 1298 to 640 patients per day postintervention, representing a 50.7% reduction.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active/statistics & numerical data , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Disaster Planning/organization & administration , HIV Infections/drug therapy , Anti-Retroviral Agents/supply & distribution , COVID-19/epidemiology , COVID-19/psychology , Delivery of Health Care/methods , Humans , Kenya/epidemiology , Physical Distancing , SARS-CoV-2
16.
Lancet HIV ; 8(3): e158-e165, 2021 03.
Article in English | MEDLINE | ID: covidwho-1062697

ABSTRACT

BACKGROUND: The effect of the COVID-19 pandemic on HIV outcomes in low-income and middle-income countries is poorly described. We aimed to measure the impact of the 2020 national COVID-19 lockdown on HIV testing and treatment in KwaZulu-Natal, South Africa, where 1·7 million people are living with HIV. METHODS: In this interrupted time series analysis, we analysed anonymised programmatic data from 65 primary care clinics in KwaZulu-Natal province, South Africa. We included data from people testing for HIV, initiating antiretroviral therapy (ART), and collecting ART at participating clinics during the study period, with no age restrictions. We used descriptive statistics to summarise demographic and clinical data, and present crude summaries of the main outcomes of numbers of HIV tests per month, ART initiations per week, and ART collection visits per week, before and after the national lockdown that began on March 27, 2020. We used Poisson segmented regression models to estimate the immediate impact of the lockdown on these outcomes, as well as post-lockdown trends. FINDINGS: Between Jan 1, 2018, and July 31, 2020, we recorded 1 315 439 HIV tests. Between Jan 1, 2018, and June 15, 2020, we recorded 71 142 ART initiations and 2 319 992 ART collection visits. We recorded a median of 41 926 HIV tests per month before lockdown (January, 2018, to March, 2020; IQR 37 838-51 069) and a median of 38 911 HIV tests per month after lockdown (April, 2020, to July, 2020; IQR 32 699-42 756). In the Poisson regression model, taking into account long-term trends, lockdown was associated with an estimated 47·6% decrease in HIV testing in April, 2020 (incidence rate ratio [IRR] 0·524, 95% CI 0·446-0·615). ART initiations decreased from a median of 571 per week before lockdown (IQR 498-678), to 375 per week after lockdown (331-399), with an estimated 46·2% decrease in the Poisson regression model in the first week of lockdown (March 30, 2020, to April 5, 2020; IRR 0·538, 0·459-0·630). There was no marked change in the number of ART collection visits (median 18 519 visits per week before lockdown [IQR 17 074-19 922] vs 17 863 visits per week after lockdown [17 509-18 995]; estimated effect in the first week of lockdown IRR 0·932, 95% CI 0·794-1·093). As restrictions eased, HIV testing and ART initiations gradually improved towards pre-lockdown levels (slope change 1·183/month, 95% CI 1·113-1·256 for HIV testing; 1·156/month, 1·085-1·230 for ART initiations). INTERPRETATION: ART provision was generally maintained during the 2020 COVID-19 lockdown, but HIV testing and ART initiations were heavily impacted. Strategies to increase testing and treatment initiation should be implemented. FUNDING: Wellcome Trust, Africa Oxford Initiative.


Subject(s)
Anti-HIV Agents/therapeutic use , COVID-19/prevention & control , HIV Infections/diagnosis , HIV Infections/drug therapy , Mass Screening/statistics & numerical data , Primary Health Care/statistics & numerical data , Adolescent , Adult , Ambulatory Care Facilities , Antiretroviral Therapy, Highly Active , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Interrupted Time Series Analysis , Male , Middle Aged , Public Health Surveillance , SARS-CoV-2 , South Africa , Young Adult
18.
HIV Med ; 22(5): 372-378, 2021 05.
Article in English | MEDLINE | ID: covidwho-998932

ABSTRACT

OBJECTIVES: A prior T cell depletion induced by HIV infection may carry deleterious consequences in the current COVID-19 pandemic. Clinical data on patients co-infected with HIV and SARS-CoV-2 are still scarce. METHODS: This multicentre cohort study evaluated risk factors for morbidity and mortality of COVID-19 in people living with HIV (PLWH), infected with SARS-CoV-2 in three countries in different clinical settings. COVID-19 was clinically classified as to be mild-to-moderate or severe. RESULTS: Of 175 patients, 49 (28%) had severe COVID-19 and 7 (4%) patients died. Almost all patients were on antiretroviral therapy (ART) and in 94%, HIV RNA was below 50 copies/mL prior to COVID-19 diagnosis. In the univariate analysis, an age 50 years or older, a CD4+ T cell nadir of < 200/µl, current CD4+ T cells < 350/µl and the presence of at least one comorbidity were significantly associated with severity of COVID-19. No significant association was found for gender, ethnicity, obesity, a detectable HIV RNA, a prior AIDS-defining illness, or tenofovir (which was mainly given as alafenamide) or protease inhibitor use in the current ART. In a multivariate analysis, the only factor associated with risk for severe COVID-19 was a current CD4+ T cell count of < 350/µl (adjusted odds ratio 2.85, 95% confidence interval 1.26-6.44, p=0.01). The only factor associated with mortality was a low CD4 T cell nadir. CONCLUSIONS: In PLWH, immune deficiency is a possible risk factor for severe COVID-19, even in the setting of virological suppression. There is no evidence for a protective effect of PIs or tenofovir alafenamide.


Subject(s)
Antiretroviral Therapy, Highly Active/methods , CD4-Positive T-Lymphocytes/metabolism , COVID-19/mortality , HIV Infections/drug therapy , Adult , Age Factors , Aged , COVID-19/immunology , Cohort Studies , Coinfection , Germany/epidemiology , HIV Infections/immunology , HIV Infections/mortality , Humans , Italy/epidemiology , Middle Aged , RNA, Viral/genetics , Risk Assessment , Severity of Illness Index , Spain/epidemiology , Viral Load , Young Adult
20.
Int J STD AIDS ; 31(13): 1320-1322, 2020 11.
Article in English | MEDLINE | ID: covidwho-781351

ABSTRACT

We report the case of a 38 year-old man living with well-controlled HIV on antiretroviral therapy who developed cerebellar symptoms and was admitted to hospital for management of an intraventricular cryptococcoma. During his hospital stay he contracted SARS CoV-2 infection within the hospital setting with a fatal outcome.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus/isolation & purification , HIV Infections/complications , Healthcare-Associated Pneumonia/diagnosis , Lung/diagnostic imaging , Pneumonia, Viral/diagnosis , Adult , Antiretroviral Therapy, Highly Active , Betacoronavirus , COVID-19 , Coinfection , Coronavirus/genetics , Coronavirus Infections/complications , Cryptococcus neoformans/isolation & purification , HIV Infections/drug therapy , Humans , Male , Pandemics , Pneumonia, Viral/complications , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Tomography, X-Ray Computed
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