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. 2024 Nov 1;14(10):e084244.
doi: 10.1136/bmjopen-2024-084244.

Assessing the impact of COVID-19 on HIV care cascade for people living with HIV in Ethiopia: a retrospective longitudinal study

Abebe Feyissa Amhare  1   2 , Mingwang Shen  1 , Zhuoru Zou  3 , Ruyi Xia  1 , Jing Han  3 , Liangmin Gao  4 , Lei Zhang  5   6   7
Affiliations

Assessing the impact of COVID-19 on HIV care cascade for people living with HIV in Ethiopia: a retrospective longitudinal study

Abebe Feyissa Amhare et al. BMJ Open. .

Abstract

Objective: The study aimed to investigate the impact of COVID-19 on the cascade of HIV care for people living with HIV (PLHIV) in Ethiopia.

Design: A retrospective longitudinal study.

Setting: The study was conducted in North Showa Zone, Ethiopia, from pre-COVID-19 (January 2018-December 2019) and during COVID-19 (January 2020-December 2021).

Participants: We identified 61901 records from 3925 PLHIV, of which 23 848 were recorded during the pandemic.

Main outcome measure: We investigated indicators from four stages of the HIV care cascade, including HIV screening and diagnosis, HIV care, HIV treatment and HIV disease progression, according to a WHO framework. The indicator changes were assessed with incidence rate ratios (IRRs).

Results: For HIV screening and diagnosis, the monthly number of HIV tests experienced a 46% decline from 2520 to 1361 since the pandemic (IRR 0.553; 95% CI 0.546 to 0.561). For HIV care, the monthly number of consultations was reduced by 49.6% (from 1582 to 798) since the pandemic (IRR 0.591; 95% CI 0.581 to 0.601). Similarly, the monthly number of viral load tests was reduced by 42.8% (IRR 0.614; 95% CI 0.581 to 0.650). For HIV treatment, the number of antiretroviral therapy (ART) initiations was reduced by 27.8% and the number of ART adherence by 52.5% since the pandemic. For HIV disease progression, the monthly number of PLHIV achieving viral suppression was reduced by 61.6%, while HIV-related deaths doubled during the pandemic.

Conclusion: The study highlights pandemic-induced disruptions in the cascade of care for PLHIV. Targeted interventions are necessary to protect PLHIV in public health emergencies.

Keywords: COVID-19; HIV & AIDS; Health Services.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. HIV care continuums. The HIV care continuum diagram has been adapted and modified according to the WHO guidelines. This modified representation highlights the stages involved in the continuum of HIV care as recommended by WHO, emphasising the critical steps from HIV diagnosis to viral suppression.
Figure 2
Figure 2. Interruption of HIV screening and diagnosis in North Showa Zone, Oromia region, Ethiopia, from 2018 to 2021. IRR, incidence rate ratio; No., number; *p<0.05.
Figure 3
Figure 3. Interruption of HIV care of people living with HIV in North Showa Zone, Oromia region, Ethiopia, from 2018 to 2021. IRR, incidence rate ratio; No., number; *p<0.05.
Figure 4
Figure 4. Interruption of HIV treatment of people living with HIV in North Showa Zone, Oromia region, Ethiopia, from 2018 to 2021. ART, antiretroviral therapy; IRR, incidence rate ratio; No., number; *p<0.05.
Figure 5
Figure 5. Interruption of HIV disease progression of people living with HIV in North Showa Zone, Oromia region, Ethiopia, from 2018 to 2021. IRR, incidence rate ratio; No., number; U, Mann-Whitney U test; *p<0.05.
Figure 6
Figure 6. Scatter plots of viral load and CD4 counts of people living with HIV from January 2018 to December 2021 in North Showa Zone, Oromia region, Ethiopia.
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