The Impact of COVID-19 on the HIV Cascade of Care in Botswana - An Interrupted Time Series

Abstract

Globally, Botswana has one of the highest burdens of HIV. This study estimated the impact of the COVID-19 pandemic on the HIV cascade of care in Sub-Saharan Africa. We conducted an interrupted time series analysis on national-level data to estimate the effect of COVID-19 on the numbers of HIV tests, positive HIV tests and ART initiations from April 2019 until March 2021. In multivariable Poisson interrupted time series regression, the COVID-19 lockdown was associated with a 27% decrease in the monthly numbers of HIV tests (IRR 0.73, 95%CI 0.72-0.73), a 25% decrease in HIV positive tests (IRR 0.75, 95%CI 0.71-0.79), and a 43% reduction in ART initiations (IRR 0.57, 95%CI 0.55-0.60). The impact of the pandemic on all three outcomes was worse in males and those aged ≥ 50 years. In conclusion, COVID-19 had a strong negative impact on HIV screening, diagnosis and ART initiation in Botswana.

Keywords: Antiretroviral therapy (ART) initiation; Botswana; COVID-19; HIV cascade of care; HIV screening; Human immunodeficiency virus (HIV); Sub-saharan africa.

Fig. 1

Fitted values of monthly HIV tests by COVID-19 period. NB: The solid line represents the number of HIV test results observed and the dotted line shows what could have been expected in the absence of COVID-19

Fig. 2

Fitted values of monthly HIV-positive tests by COVID-19 period. NB: The solid line represents the number of HIV positive tests and the dotted line (counterfactual) shows what could have been expected in the absence of COVID-19

Fig. 3

Fitted values of monthly overall ART initiations by COVID-19 period. NB: The solid line represents the number of ART initiations, and the dotted line (counterfactual) shows what could have been expected in the absence of COVID-19.