Transient Reductions in Human Immunodeficiency Virus (HIV) Clinic Attendance and Food Security During the Coronavirus Disease 2019 (COVID-19) Pandemic for People Living With HIV in 4 African Countries

Abstract

The coronavirus disease 2019 (COVID-19) pandemic and associated public health responses have disrupted daily living activities with economic and health consequences globally. We observed transient decreases in human immunodeficiency virus (HIV) clinic visit adherence and food security among persons living with HIV early in the pandemic, and an increase in viral suppression later in the pandemic.

Keywords: COVID-19 pandemic; East Africa; HIV; West Africa; food security.

Figure 1.

Adjusted ORs for associations between early and late COVID-19 periods and (A) HIV care among PLWH, (B) food security among PLWH, and (C) food security among people without HIV. The main comparison of interest was between study visits before and during the COVID-19 pandemic, among participants with both types of visits. The pre–COVID-19 period was 1 January 2019 to 19 March 2020 and the COVID-19 period was 7 May 2020 to 28 February 2021. The median post–COVID-19 visit date, 7 September 2020, was used to split the COVID-19 period into early and late phases to assess potential differences over the course of the pandemic. Logistic regression with generalized estimating equations, clustered by participant to account for repeated measures, was used to estimate ORs and 95% CIs comparing HIV care and food security before and during the pandemic. Models were stratified by HIV status and adjusted for age, sex, and program. Although all available data were utilized, only a subset of PLWH, those attending an in-person visit during COVID-19, had viral load data available during the COVID-19 period (n = 1392 [96.2%] with available viral load data pre–COVID-19 and n = 871 [60.2%] with viral load data available during COVID-19). Note: 1 participant seroconverted between their study visit before COVID-19 and their study visit during COVID-19 and was omitted from all analyses. ¹ART adherence: defined as no self-reported missed doses of ART in the past 30 days. ²Viral suppression: defined as a viral load <1000 copies/mL after being on ART for ≥6 months. ³Clinic visit adherence: defined as no self-reported missed HIV clinic visits in the past 6 months; different than AFRICOS study visits. ⁴Enough food to eat: defined as having enough food to eat in the past 12 months. ⁵Meals reduced: defined as ≥1 meals cut or reduced in size per day on average because there was not enough food or money for food. Abbreviations: AFRICOS, African Cohort Study; ART, antiretroviral therapy; CI, confidence interval; COVID-19, coronavirus disease 2019; HIV, human immunodeficiency virus; OR, odds ratio; PLWH, people living with HIV.