The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: an interrupted time series analysis.
The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: an interrupted time series analysis.
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DOI：
10.1016/s2352-3018(20)30359-3
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Garrett N
中科院分区：
文献类型：
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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
新冠大流行对中低收入国家艾滋病防治成果的影响鲜见描述。我们旨在衡量2020年南非夸祖鲁 - 纳塔尔省全国新冠封锁措施对艾滋病检测和治疗的影响，该省有170万人感染艾滋病病毒。
在这项中断时间序列分析中，我们分析了来自南非夸祖鲁 - 纳塔尔省65家初级保健诊所的匿名项目数据。我们纳入了研究期间在参与诊所进行艾滋病检测、开始抗逆转录病毒治疗（ART）以及领取抗逆转录病毒药物的人员的数据，无年龄限制。我们使用描述性统计来总结人口统计学和临床数据，并呈现2020年3月27日开始的全国封锁前后每月艾滋病检测数量、每周抗逆转录病毒治疗启动数量以及每周抗逆转录病毒药物领取次数等主要结果的粗略汇总。我们使用泊松分段回归模型来估计封锁对这些结果的即时影响以及封锁后的趋势。
2018年1月1日至2020年7月31日期间，我们记录了1315439次艾滋病检测。2018年1月1日至2020年6月15日期间，我们记录了71142次抗逆转录病毒治疗启动和2319992次抗逆转录病毒药物领取。我们记录到封锁前每月艾滋病检测中位数为41926次（2018年1月至2020年3月；四分位距37838 - 51069），封锁后每月艾滋病检测中位数为38911次（2020年4月至2020年7月；四分位距32699 - 42756）。在泊松回归模型中，考虑到长期趋势，封锁与2020年4月艾滋病检测估计减少47.6%相关（发病率比[IRR] 0.524，95%置信区间0.446 - 0.615）。抗逆转录病毒治疗启动从封锁前每周中位数571次（四分位距498 - 678）下降到封锁后每周375次（331 - 399），在封锁第一周（2020年3月30日至2020年4月5日）的泊松回归模型中估计减少46.2%（IRR 0.538，0.459 - 0.630）。抗逆转录病毒药物领取次数没有显著变化（封锁前每周中位数18519次领取[四分位距17074 - 19922]与封锁后每周17863次领取[17509 - 18995]；封锁第一周估计影响IRR 0.932，95%置信区间0.794 - 1.093）。随着限制放宽，艾滋病检测和抗逆转录病毒治疗启动逐渐向封锁前水平改善（艾滋病检测斜率变化为每月1.183，95%置信区间1.113 - 1.256；抗逆转录病毒治疗启动为每月1.156，1.085 - 1.230）。
在2020年新冠封锁期间，抗逆转录病毒药物供应总体上得以维持，但艾滋病检测和抗逆转录病毒治疗启动受到严重影响。应实施增加检测和治疗启动的策略。
维康信托基金，非洲牛津倡议
The effect of the COVID-19 pandemic on HIV outcomes in low-income and middle-income countries is poorly described. We aimed to measure the impact of the 2020 national COVID-19 lockdown on HIV testing and treatment in KwaZulu-Natal, South Africa, where 1·7 million people are living with HIV. In this interrupted time series analysis, we analysed anonymised programmatic data from 65 primary care clinics in KwaZulu-Natal province, South Africa. We included data from people testing for HIV, initiating antiretroviral therapy (ART), and collecting ART at participating clinics during the study period, with no age restrictions. We used descriptive statistics to summarise demographic and clinical data, and present crude summaries of the main outcomes of numbers of HIV tests per month, ART initiations per week, and ART collection visits per week, before and after the national lockdown that began on March 27, 2020. We used Poisson segmented regression models to estimate the immediate impact of the lockdown on these outcomes, as well as post-lockdown trends. Between Jan 1, 2018, and July 31, 2020, we recorded 1 315 439 HIV tests. Between Jan 1, 2018, and June 15, 2020, we recorded 71 142 ART initiations and 2 319 992 ART collection visits. We recorded a median of 41 926 HIV tests per month before lockdown (January, 2018, to March, 2020; IQR 37 838–51 069) and a median of 38 911 HIV tests per month after lockdown (April, 2020, to July, 2020; IQR 32 699–42 756). In the Poisson regression model, taking into account long-term trends, lockdown was associated with an estimated 47·6% decrease in HIV testing in April, 2020 (incidence rate ratio [IRR] 0·524, 95% CI 0·446–0·615). ART initiations decreased from a median of 571 per week before lockdown (IQR 498–678), to 375 per week after lockdown (331–399), with an estimated 46·2% decrease in the Poisson regression model in the first week of lockdown (March 30, 2020, to April 5, 2020; IRR 0·538, 0·459–0·630). There was no marked change in the number of ART collection visits (median 18 519 visits per week before lockdown [IQR 17 074–19 922] vs 17 863 visits per week after lockdown [17 509–18 995]; estimated effect in the first week of lockdown IRR 0·932, 95% CI 0·794–1·093). As restrictions eased, HIV testing and ART initiations gradually improved towards pre-lockdown levels (slope change 1·183/month, 95% CI 1·113–1·256 for HIV testing; 1·156/month, 1·085–1·230 for ART initiations). ART provision was generally maintained during the 2020 COVID-19 lockdown, but HIV testing and ART initiations were heavily impacted. Strategies to increase testing and treatment initiation should be implemented. Wellcome Trust, Africa Oxford Initiative.