Protecting the gains: analysis of HIV treatment and service delivery programme data and interventions implemented in 19 African countries during COVID-19

Abstract

Introduction: The potential disruption in antiretroviral therapy (ART) services in Africa at the start of the COVID-19 pandemic raised concern for increased morbidity and mortality among people living with HIV (PLHIV). We describe HIV treatment trends before and during the pandemic and interventions implemented to mitigate COVID-19 impact among countries supported by the US Centers for Disease Control and Prevention (CDC) through the President's Emergency Plan for AIDS Relief (PEPFAR).

Methods: We analysed quantitative and qualitative data reported by 10,387 PEPFAR-CDC-supported ART sites in 19 African countries between October 2019 and March 2021. Trends in PLHIV on ART, new ART initiations and treatment interruptions were assessed. Viral load coverage (testing of eligible PLHIV) and viral suppression were calculated at select time points. Qualitative data were analysed to summarize facility- and community-based interventions implemented to mitigate COVID-19.

Results: The total number of PLHIV on ART increased quarterly from October 2019 (n = 7,540,592) to March 2021 (n = 8,513,572). The adult population (≥15 years) on ART increased by 14.0% (7,005,959-7,983,793), while the paediatric population (<15 years) on ART declined by 2.6% (333,178-324,441). However, the number of new ART initiations dropped between March 2020 and June 2020 by 23.4% for adults and 26.1% for children, with more rapid recovery in adults than children from September 2020 onwards. Viral load coverage increased slightly from April 2020 to March 2021 (75-78%) and viral load suppression increased from October 2019 to March 2021 (91-94%) among adults and children combined. The most reported interventions included multi-month dispensing (MMD) of ART, community service delivery expansion, and technology and virtual platforms use for client engagement and site-level monitoring. MMD of ≥3 months increased from 52% in October 2019 to 78% of PLHIV ≥ age 15 on ART in March 2021.

Conclusions: With an overall increase in the number of people on ART, HIV programmes proved to be resilient, mitigating the impact of COVID-19. However, the decline in the number of children on ART warrants urgent investigation and interventions to prevent further losses experienced during the COVID-19 pandemic and future public health emergencies.

Keywords: COVID-19; differentiated care; retention; treatment; treatment interruption; viral suppression.

Figure 1

Trends in the total number of people living with HIV (PLHIV) on treatment, number of newly initiated PLHIV on treatment and the proportion of interruptions in treatment for adults (≥15) and children (<15) across 19 Centers for Disease Control‐President's Emergency Program for AIDS Relief‐Supported African Countries from October 2019 to March 2021.

Figure 2

Trends in the total number of people living with HIV (PLHIV) on treatment, number of newly initiated PLHIV on treatment and the proportion of interruptions in treatment for adults (≥15) from October 2019 to March 2021 across five highlighted Centers for Disease Control‐President's Emergency Program for AIDS Relief‐Supported Countries.

Figure 3

Trends in the total number of children living with HIV (CLHIV) on treatment, number of newly initiated CLHIV on treatment and the proportion of interruptions in treatment for chidren and adolescents (<15) from October 2019 to March 2021 across five highlighted Centers for Disease Control‐President's Emergency Program for AIDS Relief‐Supported Countries.

Figure 4

Trends in the scale up of multi‐month dispensing of ART 3–5 months and 6 months or more among adults (≥15 years) and children (<15 years) across 19 Centers for Disease Control‐President's Emergency Program for AIDS Relief‐Supported African Countries from October 2019 to March 2021.