Protecting the gains: analysis of HIV treatment and service delivery programme data and interventions implemented in 19 African countries during COVID‐19
Authors: Bachanas Pamela J. , Chun Helen M. , Mehta Neha , Aberle‐Grasse John , Parris KaeAnne , Sherlock Michelle Williams , Lloyd Spencer , Zeh Clement , Makwepa Daphne K. , Kapanda Max L. , Dokubo Emily Kainne , Bonono Leonard , Balachandra Shirish , Ehui Eboi , Fonjungo Peter , Nkoso Aimé M. , Mazibuko Sikhathele , Okello Velephi N. , Tefera Fana , Getachew Mirtie , Katiku Elizabeth M. , Mulwa Andrew , Asiimwe Fred M. , Tarumbiswa Tapiwa F. , Auld Andrew F. , Nyirenda Rose , Dos Santos De Louvado Alzira P. , Gaspar Irenio , Hong Steven Y. , Ashipala Laimi , Obanubi Christopher , Ikpeazu Akudo , Musoni Canisious , Yoboka Emmanuel , Mthethwa Simangele , Pinini Zukiswa , Bunga Sudhir , Rumunu John , Magesa Daniel J. , Mutayoba Beatrice , Nelson Lisa J. , Katureebe Cordelia , Agolory Simon , Mulenga Lloyd B. , Nyika Ponesai , Mugurungi Owen , Ellerbrock Tedd , Mitruka Kiren 
Published: November 2022

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.