COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study
Authors: Chilot Dagmawi , Woldeamanuel Yimtubezinash , Manyazewal Tsegahun 
Published: July 2021

Background
There has been promising progress towards screening, testing, and retaining HIV patients in care in Ethiopia. Concern exists that possible disruptions in HIV programs due to COVID-19 could result in more HIV-related mortality and new HIV infections. This study aimed to investigate the real-time burden of COVID-19 on HIV patients attending antiretroviral therapy.
Methods
We conducted a facility-based, multicentre, cross-sectional study among HIV patients attending antiretroviral therapy in 10 healthcare facilities in Addis Ababa, Ethiopia, in the COVID-19 pandemic period. Data was collected using adapted, interviewer-based questionnaires, and entered into Epi Info version 7 and exported to SPSS version 26 for analysis.
Result
A total of 212 patients with HIV were included. Participants who missed visits for refill were 58 (27.4%). When the effects of other independent variables on appointments/visits for refill were controlled, the following characteristics were found to be the most important pridictors of missed appointments (P < 0.05): age ≥ 55 [AOR = 6.73, 95% CI (1.495–30.310)], fear of COVID-19 [AOR = 24.93, 95% CI (2.798-222.279)], transport disruption [AOR = 4.90, 95% CI (1.031–23.174)], reduced income for traveling to health facility [AOR = 5.64, 95% CI (1.234–25.812)], and limited access to mask [AOR = 7.67, 95% CI (1.303–45.174)], sanitizer [AOR = 0.07, 95% CI (0.007–0.729)] and non-medical support [AOR = 2.32, 95% CI (1.547–12.596)]. The participants were well aware of the COVID-19 preventive measures. The most costly COVID-19 preventive measures that cause financial burden to the patients were costs for buying facemasks (63.7%), disinfectants (55.2) and sops for handwashing (22.2). Participants who missed follow-up diagnostic tests were 56 (26.4%). Variables which were found to be statistically significant include the following: age ≥ 55 [AOR = 0.22, 95% CI (0.076–0.621)], partial lockdown [AOR = 0.10, 95% CI (0.011–0.833)], limited access to health services [AOR = 0.15, 95% CI (0.045–0.475)], reduced income for traveling to health facility [AOR = 0.18, 95% CI (0.039–0.784)], and unable to get mask [AOR = 0.12, 95% CI (0.026–0.543)]. Participants who missed counseling services were 55 (25.9%). In multivariate logistic regression the following were statisticaly significant: age ≥ 55 [AOR = 0.21, 95% CI (0.078–0.570)], fear of COVID-19 [AOR = 0.11, 95% CI (0.013–0.912)], reduced income [AOR = 0.17, 95% CI (0.041–0.699)], unable to get face mask [AOR = 0.19, 95%CI (0.039–0.959)], and partial lockdown [AOR = 0.08, 95% CI (0.008–0.790)].
Conclusions
COVID-19 had a significant burden on HIV patients to attend their routine clinical care and treatment, which may lead to treatment failure and drug resistance. The impact was on their appointments for medication refills and clinical and laboratory follow-ups. Targeted initiatives are needed to sustain HIV clinical care and treatment services and improve the wellbeing of people living with HIV.