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

• Published in: BMJ open 2024-11, Vol.14 (10), p.e084244
• Main Authors: Amhare, Abebe Feyissa, Shen, Mingwang, Zou, Zhuoru, Xia, Ruyi, Han, Jing, Gao, Liangmin, Zhang, Lei
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; COVID-19; COVID-19 - epidemiology; COVID-19 - therapy; Disease Progression; Disease transmission; Ethiopia - epidemiology; Female; Health Services; HIV; HIV & AIDS; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Testing - statistics & numerical data; Human immunodeficiency virus; Humans; Infectious diseases; Longitudinal Studies; Male; Middle Aged; Pandemics; Retrospective Studies; SARS-CoV-2; Young Adult
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2024-084244

ObjectiveThe study aimed to investigate the impact of COVID-19 on the cascade of HIV care for people living with HIV (PLHIV) in Ethiopia.DesignA retrospective longitudinal study.SettingThe study was conducted in North Showa Zone, Ethiopia, from pre-COVID-19 (January 2018–December 2019) and during COVID-19 (January 2020–December 2021).ParticipantsWe identified 61901 records from 3925 PLHIV, of which 23 848 were recorded during the pandemic.Main outcome measureWe 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).ResultsFor 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.ConclusionThe study highlights pandemic-induced disruptions in the cascade of care for PLHIV. Targeted interventions are necessary to protect PLHIV in public health emergencies.