Short-Term Effects of the COVID-19 Pandemic on HIV Care Utilization, Service Delivery, and Continuity of HIV Antiretroviral Treatment (ART) in Haiti.
Short-Term Effects of the COVID-19 Pandemic on HIV Care Utilization, Service Delivery, and Continuity of HIV Antiretroviral Treatment (ART) in Haiti.
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DOI：
10.1007/s10461-021-03218-8
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发表时间：
2021-05
影响因子：
4.4
通讯作者：
Puttkammer N
中科院分区：
文献类型：
--
作者：
Celestin K;Allorant A;Virgin M;Marinho E;Francois K;Honoré JG;White C;Valles JS;Perrin G;De Kerorguen N;Flowers J;Balan JG;Koama JBT;Barnhart S;Puttkammer N
我们的研究描述了 2020 年 3 月 19 日海地诊断出首例 2019 年冠状病毒病 (COVID-19) 病例前后 8 周内，艾滋病毒感染者 (PLHIV) 的艾滋病毒护理服务提供情况和艾滋病毒抗逆转录病毒治疗 (ART) 连续性的变化。利用提供 ART 服务的 167 家卫生机构中的 96 家的数据，我们比较了 4 个 ART 项目指标：(1) HIV 就诊次数； (2) 社区环境 (DAC) 中 ART 配药的比例； (3) 多月配发 ART 药物的比例 > 6 个月 (> 6 m MMD)； (4) 及时补充 ART 的比例。我们使用不受控制的中断时间序列 (ITS) 模型来估计每个指标随着 COVID-19 的到来而发生的斜率和水平变化。从第1周到第16周，平均HIV就诊次数从121.5人次下降到92.5人次，DAC比例从22.7%上升到36.7%， > 6 m MMD比例从29.4%上升到48.4%，及时补充ART的比例从51.9%下降到43.8%。 ITS 模型估计，在 COVID-19 到来时， > 6 m MMD 突然增加 36% (p < 0.001)，DAC 突然增加 37% (p< 0.001)，而在 COVID-19 到来后没有变化。随着 COVID-19 的到来，及时补充 ART 的数量突然下降了 18%，此后每周下降了 1%，这两个变化都没有统计学意义。 HIV 服务利用率的突然变化意味着需要进行巨大的调整，以减轻 COVID-19 大流行对 PLHIV 的主要和次要影响。这项研究强调了在海地及其他地区优化抗逆转录病毒治疗交付模式的紧迫性，以保持艾滋病毒流行控制的进展。
Our study describes changes in HIV care service delivery and continuity of HIV antiretroviral therapy (ART) for people living with HIV (PLHIV) during the 8 weeks before and after diagnosis of the first coronavirus disease 2019 (COVID-19) cases in Haiti on March 19, 2020. Using data from 96 out of 167 health facilities offering ART services, we compared four ART program indicators: (1) count of HIV visits; (2) proportion of ART dispenses in community-based settings (DAC); (3) proportion of multi-month dispensing of ART medications > 6 months (> 6 m MMD); and (4) proportion of timely ART refills. We used uncontrolled interrupted time series (ITS) models to estimate slope and level changes in each indicator with the arrival of COVID-19. From week 1 to week 16, the average number of HIV visits fell from 121.5 to 92.5 visits, the proportion of DAC rose from 22.7% to 36.7%, the proportion of > 6 m MMD rose from 29.4% to 48.4%, and the proportion of timely ART refills fell from 51.9% to 43.8%. The ITS models estimated abrupt increases of 36% in > 6 m MMD (p < 0.001) and 37% in DAC (p < 0.001) at the time of COVID-19 arrival, and no change after arrival of COVID-19. The was an abrupt decline of 18% in timely ART refills with the arrival of COVID-19 and a decline of 1% per week thereafter, both non-statistically significant changes. The sudden changes in HIV service utilization represent dramatic adaptations needed to mitigate primary and secondary effects of the COVID-19 pandemic on PLHIV. This study underscores the urgency of optimizing ART delivery models in Haiti and beyond, in order to maintain progress toward HIV epidemic control.
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