Impact of the COVID-19 pandemic on HIV prevention and care services among key populations across 15 cities in India: a longitudinal assessment of clinic-based data.

Impact of the COVID-19 pandemic on HIV prevention and care services among key populations across 15 cities in India: a longitudinal assessment of clinic-based data.
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DOI:
10.1002/jia2.25960
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发表时间:
2022-07
影响因子:
6
通讯作者:
Mehta, Shruti H.
Mehta, Shruti H.
中科院分区:
医学1区
文献类型:
--
作者:
McFall, Allison M.;Menezes, Neia Prata;Srikrishnan, Aylur K.;Solomon, Sunil S.;Anand, Santhanam;Baishya, Jiban J.;Lucas, Gregory M.;Celentano, David D.;Mehta, Shruti H.

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COVID-19 大流行有可能削弱艾滋病毒流行控制方面的成果,并且对资源有限环境中的关键人群的影响可能最为深远。我们的目的是了解该流行病对印度各地男男性行为者 (MSM) 和注射吸毒者 (PWID) 的艾滋病毒相关服务利用的影响。从 2013 年开始,我们在印度 15 个地点建立了综合护理中心 (ICC),为男男性行为者和注射吸毒者提供艾滋病毒预防和治疗服务。我们研究了大流行前 2 个月(2020 年 1 月至 2 月)以及印度第一波和第二波 COVID-19 浪潮(2020 年 3 月至 2021 年 6 月)期间 18 个月的使用模式。我们评估了:(1) 访问任何 ICC 服务的独特客户,(2) 提供的 ICC 服务,(3) 接受 HIV 检测的独特客户,以及 (4) HIV 诊断和检测呈阳性。在已确定的吸毒者/男男性行为者艾滋病毒感染者 (PLHIV) 队列中,我们开展了一项关于该流行病对艾滋病毒护理和治疗影响的调查(2020 年 6 月至 8 月)。总体而言,2020年1月至2021年6月期间,有13,854名独立客户访问了ICC。2020年1月/2月,平均每月客户数量为3761人。与大流行前的水平相比,2020年3月接受服务的客户数量大幅下降,2020年4月/5月(第一波)降至大流行前水平的25%,随后缓慢反弹,直到4/5月2021年(第二波),下降了57%。艾滋病毒检测也遵循类似的轨迹。 HIV 检测阳性率随着时间的推移而变化,在第一波浪潮中下降,并在 2020 年 7 月左右达到最低点,约为大流行前水平的 50%。随后,积极性稳步上升,最终高于大流行前时期。第二波与 MSM 的阳性率下降有关,但吸毒者的阳性率相对没有变化。在接受调查的 1650 名艾滋病病毒感染者中,52% 的吸毒者和 45% 的男男性行为者表示,疫情影响了他们寻求艾滋病毒提供者的帮助。 MSM 在获得性传播感染检测和伴侣艾滋病毒检测方面存在障碍。 COVID-19 大流行导致印度重点人群中与艾滋病毒相关的服务利用率大幅下降。这为已经受到艾滋病毒影响尤为严重的群体中的传播增加和患有晚期疾病的患者提供了机会。
The COVID‐19 pandemic has threatened to diminish gains in HIV epidemic control and impacts are likely most profound among key populations in resource‐limited settings. We aimed to understand the pandemic's impact on HIV‐related service utilization among men who have sex with men (MSM) and people who inject drugs (PWID) across India. Beginning in 2013, we established integrated care centres (ICCs) which provide HIV preventive and treatment services to MSM and PWID across 15 Indian sites. We examined utilization patterns for an 18‐month period covering 2 months preceding the pandemic (January–February 2020) and over the first and second COVID‐19 waves in India (March 2020–June 2021). We assessed: (1) unique clients accessing any ICC service, (2) ICC services provided, (3) unique clients tested for HIV and (4) HIV diagnoses and test positivity. Among an established cohort of PWID/MSM living with HIV (PLHIV), we administered a survey on the pandemic's impact on HIV care and treatment (June–August 2020). Overall, 13,854 unique clients visited an ICC from January 2020 to June 2021. In January/February 2020, the average monthly number of clients was 3761. Compared to pre‐pandemic levels, the number of clients receiving services declined sharply in March 2020, dropping to 25% of pre‐pandemic levels in April/May 2020 (first wave), followed by a slow rebound until April/May 2021 (second wave), when there was a 57% decline. HIV testing followed a similar trajectory. HIV test positivity changed over time, declining in the first wave and reaching its nadir around July 2020 at ∼50% of pre‐pandemic levels. Positivity then increased steadily, eventually becoming higher than pre‐pandemic periods. The second wave was associated with a decline in positivity for MSM but was relatively unchanged for PWID. Among 1650 PLHIV surveyed, 52% of PWID and 45% of MSM reported the pandemic impacted their ability to see an HIV provider. MSM had barriers accessing sexually transmitted infection testing and partner HIV testing. The COVID‐19 pandemic led to significant decreases in HIV‐related service utilization among key populations in India. This presents an opportunity for increased transmission and patients presenting with advanced disease among groups already disproportionately impacted by HIV.
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