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. 2022 Aug;7(8):e009105.
doi: 10.1136/bmjgh-2022-009105.

HIV and SARS-CoV-2: the interplay of two wicked problems

Anneleen Kiekens  1 , George Msema Bwire  1   2 , Catherine Decouttere  3 , Michael R Jordan  4   5 , Ally Mangara  6 , Idda H Mosha  7 , Tobias Rinke de Wit  8 , Raphael Zozimus Sangeda  2 , Omary Swalehe  9 , Nico Vandaele  3 , Japhet Killewo  10 , Anne-Mieke Vandamme  11   12
Affiliations

HIV and SARS-CoV-2: the interplay of two wicked problems

Anneleen Kiekens et al. BMJ Glob Health. 2022 Aug.
No abstract available

Keywords: COVID-19; HIV; health systems.

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Conflict of interest statement

Competing interests: A-MV declares consultancy fees from Gilead.

Figures

Figure 1
Figure 1
Interlinkage of the HIV and COVID-19 CAS at the international level, as supported by literature (see main text). The blue, pink and purple loops are feedback loops identified in the HIVDR CAS. The yellow elements are related to the COVID-19 pandemic and illustrate the interlinkage between both complex problems. Other links between the COVID-19 on the HIVDR CAS are to be expected, such as the likely increase in transmission of HIVDR due to increased sexual violence during lockdown. The 60% increase in teenage pregnancies in South Africa during the pandemic points in the same direction. ART, antiretroviral therapy; CAS, complex adaptive system; HIVDR, HIV drug resistance.
Figure 2
Figure 2
Effects of the COVID-19 pandemic and related measures on the HIVDR CAS in the study site. Between March and June 2020, social gatherings were restricted, the number of pill pick-ups was reduced, public transportation seats were limited to allow physical distancing, and patients were obliged to wear face masks at the healthcare centre, impairing access for people who were not able to afford masks. Moreover, some people were afraid of going to healthcare centres and instead bought their ART at pharmacies or chose to interrupt their treatment. Places in the system affected by government measures are indicated in blue. While the healthcare system’s HIV-related workload temporarily decreased, there was an increase in COVID-19-related workload, and due to worldwide stock-outs of reagents, laboratory capacity was reduced and delays in turnaround time of VL tests were noted. The pandemic also decreased employment opportunities. These indirect effects of the pandemic and/or pandemic measures are indicated in green. Effects on other elements are indicated with an orange arrow. ART, antiretroviral therapy; CAS, complex adaptive system; HIVDR, HIV drug resistance; NGO, Non-Governmental Organization; VL, viral load.
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