Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium.
Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium.
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DOI：
10.1002/jia2.26036
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发表时间：
2022-12
影响因子：
6
通讯作者：
Nash, Denis
中科院分区：
文献类型：
--
作者：
Brazier, Ellen;Ajeh, Rogers;Maruri, Fernando;Musick, Beverly;Freeman, Aimee;Wester, C. William;Lee, Man-Po;Shamu, Tinei;Ramirez, Brenda Crabtree;d'Almeida, Marcelline;Wools-Kaloustian, Kara;Kumarasamy, N.;Althoff, Keri N.;Twizere, Christella;Grinsztejn, Beatriz;Tanser, Frank;Messou, Eugene;Byakwaga, Helen;Duda, Stephany N.;Nash, Denis
关键词：
治疗中断对艾滋病毒感染者（PWH）构成风险，并威胁到结束艾滋病毒流行病的进展;然而，COVID-19大流行对不同环境中艾滋病毒服务提供的影响尚未得到广泛记录。从2020年9月至2021年3月，评估艾滋病的国际流行病学数据库（IeDEA）研究联盟调查了七个地理区域的238个艾滋病护理点，以记录在大流行的第一年提供艾滋病服务的限制以及确保威尔斯亲王医院护理连续性的策略。描述性统计按国家艾滋病毒流行率（<1%，1-4.9%和≥5%）和国家收入水平分层。在42个低（n = 82）、中（n = 86）和高（n = 57）HIV流行率国家的225个（95%）研究中心完成了关于HIV护理的流行病相关后果的问题，包括低收入（n = 57）、中低收入（n = 79）、中高收入（n = 39）和高收入（n = 50）国家。大多数诊所报告称，在旅行、服务提供或其他运营方面受到了与流行病相关的限制（75%），并对诊所运营产生了负面影响（76%），包括工作时间/天数减少、提供者可用性降低、诊所重新配置COVID-19服务、记录保存中断和合作伙伴支持暂停。低患病率和高收入国家的几乎所有站点都报告了远程医疗的使用增加（分别为85%和100%），而高患病率和低收入环境中的站点不到一半。在高流行率环境中，很少有研究中心（2%）报告暂停了抗逆转录病毒治疗（ART）诊所服务，许多研究中心报告采取了缓解策略以支持依从性，包括数月的ART分发（95%）和指定社区ART领取点（44%）。虽然很少有研究中心（5%）报告一线ART方案缺货，但分别有10-11%的研究中心报告二线和三线方案缺货，主要发生在高患病率和低收入环境中。HIV病毒载量（VL）检测中断包括暂停检测（22%）、周转时间延长（41%）和供应/试剂缺货（22%），但在不同环境中没有差异。虽然艾滋病毒高流行率地区和低收入国家的许多研究中心报告说，它们采取或扩大了支持治疗依从性和护理连续性的措施，但COVID-19大流行导致VL检测和ART供应链中断，这可能对这些地区的艾滋病毒护理质量产生负面影响。
Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID‐19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented. From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1–4.9% and ≥5%) and country income levels. Questions about pandemic‐related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low‐ (n = 57), lower‐middle (n = 79), upper‐middle (n = 39) and high‐ (n = 50) income countries. Most sites reported being subject to pandemic‐related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID‐19 services, record‐keeping interruptions and suspension of partner support. Almost all sites in low‐prevalence and high‐income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high‐prevalence and lower‐income settings. Few sites in high‐prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi‐month dispensing of ART (95%) and designating community ART pick‐up points (44%). While few sites (5%) reported stockouts of first‐line ART regimens, 10–11% reported stockouts of second‐ and third‐line regimens, respectively, primarily in high‐prevalence and lower‐income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings. While many sites in high HIV prevalence settings and lower‐income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID‐19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings.
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DOI：
10.1097/qad.0000000000003119
发表时间：
2022-03-01
期刊：
AIDS (London, England)
影响因子：
--
作者：
El-Nahal WG;Shen NM;Keruly JC;Jones JL;Fojo AT;Lau B;Manabe YC;Moore RD;Gebo KA;Lesko CR;Chander G
通讯作者：
Chander G
影响因子：
11.8
作者：
Guaraldi, Giovanni;Milic, Jovana;Lazarus, Jeffrey, V
通讯作者：
Lazarus, Jeffrey, V
影响因子：
1.4
作者：
Garg S;Gangadharan N;Bhatnagar N;Singh MM;Raina SK;Galwankar S
通讯作者：
Galwankar S
DOI：
10.1016/s2352-3018(20)30359-3
发表时间：
2021-03
期刊：
The lancet. HIV
影响因子：
--
作者：
Dorward J;Khubone T;Gate K;Ngobese H;Sookrajh Y;Mkhize S;Jeewa A;Bottomley C;Lewis L;Baisley K;Butler CC;Gxagxisa N;Garrett N
通讯作者：
Garrett N
影响因子：
3.7
作者：
Desta AA;Woldearegay TW;Gebremeskel E;Alemayehu M;Getachew T;Gebregzabiher G;Ghebremedhin KD;Zgita DN;Aregawi AB;Redae G
通讯作者：
Redae G