Effects of the Coronavirus Disease 2019 Pandemic on Human Immunodeficiency Virus Services: Findings from 11 Sub-Saharan African Countries.

BACKGROUND: Due to concerns about the effects of the coronavirus disease 2019 (COVID-19 pandemic on health services, we examined its effects on human immunodeficiency virus (HIV) services in sub-Saharan Africa. METHODS: Quarterly data (Q1, 10/2019-12/2019; Q2, 1/2020-3/2020; Q3, 4/2020-6/2020; Q4, 7/2020-9/2020) from 1059 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 higher vs lower stringency. RESULTS: There was a 3.3% decrease in the number HIV tested from Q2 to Q3 (572 845 to 553 780), with the number testing HIV-positive declining by 4.9% from Q2 to Q3. From Q3 to Q4, the number tested increased by 10.6% (612 646), with an increase of 8.8% (23 457) in the number testing HIV-positive with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2 to Q3 but increased in Q4 by 9.8%. Across all quarters, the number on ART increased (Q1, 419 028 to Q4, 476 010). The number receiving viral load (VL) testing in the prior 12 months increased (Q1, 255 290 to Q4, 312 869). No decrease was noted in VL suppression (Q1, 87.5% to Q4, 90.1%). HIV testing (P < .0001) and new ART initiations (P = .001) were inversely associated with stringency. CONCLUSIONS: After initial declines, rebound was brisk, with increases noted in the number HIV tested, newly initiated or currently on ART, VL testing, and VL suppression throughout the period, demonstrating HIV program resilience in the face of the COVID-19 crisis.

Achieving the first 90 for key populations in sub-Saharan Africa through venue-based outreach: challenges and opportunities for HIV prevention based on PLACE study findings from Malawi and Angola.

INTRODUCTION: Providing outreach HIV prevention services at venues (i.e. "hotspots") where people meet new sex partners can decrease barriers to HIV testing services (HTS) for key populations (KP) in sub-Saharan Africa (SSA). We offered venue-based HTS as part of bio-behavioural surveys conducted in urban Malawi and Angola to generate regional insights into KP programming gaps and identify opportunities to achieve the "first 90" for KP in SSA. METHODS: From October 2016 to March 2017, we identified and verified 1054 venues in Luanda and Benguela, Angola and Zomba, Malawi and conducted bio-behavioural surveys at 166 using the PLACE method. PLACE interviews community informants to systematically identify public venues where KP can be reached and conducts bio-behavioural surveys at a stratified random sample of venues. We present survey results using summary statistics and multivariable modified Poisson regression modelling to examine associations between receipt of outreach worker-delivered HIV/AIDS education and HTS uptake. We applied sampling weights to estimate numbers of HIV-positive KP unaware of their status at venues. RESULTS: We surveyed 959 female sex workers (FSW), 836 men who have sex with men (MSM), and 129 transgender women (TGW). An estimated 71% of HIV-positive KP surveyed were not previously aware of their HIV status, receiving a new HIV diagnosis through PLACE venue-based HTS. If venue-based HTS were implemented at all venues, 2022 HIV-positive KP (95% CI: 1649 to 2477) who do not know their status could be reached, including 1666 FSW (95% CI: 1397 to 1987), 274 MSM (95% CI: 160 to 374), and 82 TG (95% CI: 20 to 197). In multivariable analyses, FSW, MSM, and TGW who received outreach worker-delivered HIV/AIDS education were 3.15 (95% CI: 1.99 to 5.01), 3.12 (95% CI: 2.17 to 4.48), and 1.80 (95% CI: 0.67 to 4.87) times as likely, respectively, as those who did not to have undergone HTS within the last six months. Among verified venues, <=68% offered any on-site HIV prevention services. CONCLUSIONS: Availability of HTS and other HIV prevention services was limited at venues. HIV prevention can be delivered at venues, which can increase HTS uptake and HIV diagnosis among individuals not previously aware of their status. Delivering venue-based HTS may represent an effective strategy to reach the "first 90" for KP in SSA.

Mortalidad a largo plazo y pérdida del seguimiento de pacientes en terapia antirretroviral / Long-term mortality and follow-up loss of patients on antiretroviral therapy

INTRODUCCIÓN: los resultados a largo plazo de la terapia antirretroviral combinada (TARVC) en África han sido escasamente reportados. OBJETIVO: evaluar la efectividad de la TARVC a través de 2 factores determinantes: la mortalidad y la pérdida del seguimiento. MÉTODOS: estudio descriptivo, retrospectivo, longitudinal, en 1 000 adultos que comenzaron TARVC en el 2004 y fueron seguidos hasta el 2009 en el hospital "Esperança", en Luanda. RESULTADOS: el conteo basal medio de linfocitos T CD4+ fue de 147,1 cél/mm3. El 46 % se presentó con estadio clínico III o IV de la Organización Mundial de la Salud. La edad promedio fue 34,6 años. Durante 60 000 meses-personas de seguimiento (media 34 meses), 335 pacientes fallecieron, 153 fueron perdidos en el seguimiento y la retención en el tratamiento a los 5 años fue 51,2 %. La tasa cruda de muerte fue 7,9 por 100 años-persona (95 % IC 5,6-8,3). Se detectó un tiempo medio de supervivencia significativamente menor en las mujeres (39,1 meses vs. 42), en aquellos con un conteo basal de linfocitos T CD4+ menor de 200 cél/mm3 (27,3 meses vs. 32,4), en los clasificados en los estadios avanzados de la OMS (25,6 meses vs. 31,7) y en los que alcanzaban tanto criterios clínicos como inmunológicos para iniciar la terapia (30,4 meses vs. solo con inmunológicos 33,7). CONCLUSIONEs: se observó una buena retención a largo plazo y resultados clínicos. La mortalidad relativamente elevada a los 5 años presenta un desafío importante para lograr mejores resultados de la TARVC y sugiere la necesidad de reforzar las estrategias que promuevan la adherencia al tratamiento.

INTRODUCTION: long-term results of combination antiretroviral therapy (cART) in Africa have been poorly informed. OBJECTIVE: To evaluate the effectiveness of TARVC through 2 factors: mortality and follow-up loss. METHODS: A descriptive, retrospective, longitudinal study was conducted in 1000 adults who began cART in 2004 and were followed until 2009 at "Esperança" Hospital in Luanda. RESULTS: The CD4 + count mean baseline of T lymphocytes was 147.1 cells/mm3. 46 % presented with clinical stage III or IV according to World Health Organization standards. The average age was 34.6 years. During 60 000 person-months follow-up (mean 34 months), 335 patients died, 153 lost follow up and adherence to treatment after 5 years was 51.2 %. The gross mortality rate was 7.9 (95 % CI 5.6 to 8.3) 100 person-years. A significantly shorter survival mean was detected in women (39.1 months vs. 42), in those with lymphocytes CD4 + count baseline below 200 cells/mm3 (27.3 months vs. 32.4), in those classified in advanced stages according to WHO standards (25.6 months vs. 31.7) and in those reaching both clinical and immunological criteria to start therapy (30.4 months vs. 33.7 immunological only). CONCLUSIONS: A good long-term adherence to treatment and clinical outcomes were observed. The relatively high mortality after 5 years presents a major challenge for better cART results and suggests the need to strengthen strategies to promote treatment adherence.

Mortalidad a largo plazo y pérdida del seguimiento de pacientes en terapia antirretroviral / Long-term mortality and follow-up loss of patients on antiretroviral therapy

Introducción: los resultados a largo plazo de la terapia antirretroviral combinada (TARVC) en África han sido escasamente reportados. Objetivo: evaluar la efectividad de la TARVC a través de 2 factores determinantes: la mortalidad y la pérdida del seguimiento. Métodos: estudio descriptivo, retrospectivo, longitudinal, en 1 000 adultos que comenzaron TARVC en el 2004 y fueron seguidos hasta el 2009 en el hospital Esperança, en Luanda. Resultados: el conteo basal medio de linfocitos T CD4+ fue de 147,1 cél/mm³. El 46 por ciento se presentó con estadio clínico III o IV de la Organización Mundial de la Salud. La edad promedio fue 34,6 años. Durante 60 000 meses-personas de seguimiento (media 34 meses), 335 pacientes fallecieron, 153 fueron perdidos en el seguimiento y la retención en el tratamiento a los 5 años fue 51,2 por ciento. La tasa cruda de muerte fue 7,9 por 100 años-persona (95 por ciento IC 5,6-8,3). Se detectó un tiempo medio de supervivencia significativamente menor en las mujeres (39,1 meses vs. 42), en aquellos con un conteo basal de linfocitos T CD4+ menor de 200 cél/mm³ (27,3 meses vs. 32,4), en los clasificados en los estadios avanzados de la OMS (25,6 meses vs. 31,7) y en los que alcanzaban tanto criterios clínicos como inmunológicos para iniciar la terapia (30,4 meses vs. solo con inmunológicos 33,7). Conclusiones: se observó una buena retención a largo plazo y resultados clínicos. La mortalidad relativamente elevada a los 5 años presenta un desafío importante para lograr mejores resultados de la TARVC y sugiere la necesidad de reforzar las estrategias que promuevan la adherencia al tratamiento(AU)

Introduction: long-term results of combination antiretroviral therapy (cART) in Africa have been poorly informed. Objective: To evaluate the effectiveness of TARVC through 2 factors: mortality and follow-up loss. Methods: A descriptive, retrospective, longitudinal study was conducted in 1000 adults who began cART in 2004 and were followed until 2009 at Esperança Hospital in Luanda. Results: The CD4 + count mean baseline of T lymphocytes was 147.1 cells/mm3. 46 percent presented with clinical stage III or IV according to World Health Organization standards. The average age was 34.6 years. During 60 000 person-months follow-up (mean 34 months), 335 patients died, 153 lost follow up and adherence to treatment after 5 years was 51.2 percent. The gross mortality rate was 7.9 (95 percent CI 5.6 to 8.3) 100 person-years. A significantly shorter survival mean was detected in women (39.1 months vs. 42), in those with lymphocytes CD4 + count baseline below 200 cells/mm3 (27.3 months vs. 32.4), in those classified in advanced stages according to WHO standards (25.6 months vs. 31.7) and in those reaching both clinical and immunological criteria to start therapy (30.4 months vs. 33.7 immunological only). Conclusions: A good long-term adherence to treatment and clinical outcomes were observed. The relatively high mortality after 5 years presents a major challenge for better cART results and suggests the need to strengthen strategies to promote treatment adherence(AU)