COVID-19 Disruptions in Care Will Lead to Increased HIV-Related Deaths
Presenter: John Stover, Vice President and Founder, Avenir Health (Glastonbury, CT, United States)
A summary of Global Declines in HIV Testing and Reductions in New Initiators - What Does This Mean for the Future? from the session COVID-19 and HIV: Managing Overlapping Pandemics, presented July 18, 2021, at the 11th International AIDS Society (IAS) Conference on HIV Science.
According to John Stover, Vice President of Avenir Health, new projection models have determined that disruptions in healthcare services impacted by closing of facilities, cessation of services, shortage of healthcare workers, disruptions of supplies, travel restrictions, and fear of accessing health facilities owing to COVID-19 may lead to hundreds of thousands of new HIV infections as well as additional deaths from AIDS.
In early 2020, the HIV Modelling Consortium organized a multimodal analysis to determine the potential impact of COVID-19 on disruptions of key HIV services including HIV testing, antiretroviral therapy (ART) initiation and ART continuation, in 12 countries in sub-Saharan Africa. The analysis showed that a 6-month disruption would affect 50% of the population and impact a relative change in mortality over 12 months, from April 2020 to March 2021.
“Severe disruption of ART alone was predicted to increase HIV mortality by 40% to 90% over the next year, and we recommended that programs pay particular attention to maintaining treatment services to existing patients,” continued Stover.
Another study from the consortium used HIV simulation models and COVID-19 simulation models to estimate the benefits of continuing HIV services and the risk of additional COVID-19 transmission if services were maintained throughout the pandemic. “Because COVID-19 mortality is particularly low in the age group most likely to have access to HIV care, the risk from additional HIV cases was determined to be much greater as mortality among those with undiagnosed, untreated HIV is quite high,” said Stover.
As of June 2021, using the Joint United Nations Programme on HIV/AIDS (UNAIDS; 11 UN organizations that include the World Health Organization and UNICEF) services tracking tool, data on the actual duration and severity of disruptions in some countries is now available. Among countries that reported monthly service data, most, but not all, experienced declines of 40% to 80% in HIV testing during 2020. “In some countries, services rebounded by October 2020, while in others, testing remained low. Reports also show small reductions in the number of HIV-positive tests and a quicker rebound, suggesting that programs are learning how to maximize testing to reach those who are most likely to test positive,” said Stover.
Stover added that most countries did not experience reduction in the number of people on ART during 2020. UNAIDS data showed that the number of people on ART continued to increase in 2020, with a net addition of 2 million HIV-infected people on ART in 2020 over 2019. The annual increase in numbers of patients on ART is somewhat lower than 2019, indicating a possible effect of COVID-19 on new ART initiations.
“We used a prospective model for the new UNAIDS strategy of ‘End Inequalities, End AIDs as a Global AIDS Strategy 2021-2026’ to examine the scope of prevention, treatment, and social interventions. This modeling helped to define the intervention target of 95-95-95 treatment cascade while looking at the effects of COVID-19 disruptions,” noted Stover.
Projections included new HIV infections, AIDs-related deaths, and care disruptions of 3 months, 6 months, or 2 years. The analysis indicated that there may be an increase in AIDS deaths over the next few years. Stover continued, “If we can catch up with service targets by 2025, we can also get back on track to reach targeted reductions in new infections and HIV-related deaths.”
It is important to note that COVID-19 pandemic disruptions could result in 120,000 to 290,000 new HIV infections and 70,000 to 150,000 additional AIDS-related deaths over the next few years, compared to a scenario with no disruptions. “We can get back on track by 2025, but the slower impact in the years leading up to 2025 may leave a gap that cannot be rectified,” he said. “Long-term effects can be minimized, but only if we maintain a fairly high level of services now and catch up for lost progress once the pandemic is under control.”
Most programs offering essential HIV services have responded well to the challenges of the COVID-19 pandemic by expanding multiple-month drug supply, delivering medications to patients in homes, expanding use of cell tests, as well as other approaches.
Disclosures
John Stover reported nothing to disclose.
References
Global HIV Prevention Coalition. Preventing HIV infections at the time of a new pandemic: A synthesis report on programme disruptions and adaptations during the COVID-19 pandemic in 2020. Accessed July 18, 2021. https://www.unaids.org/sites/default/files/media_asset/Status%20of%20HIV%20Prevention%20Services%20in%20the%20Time%20of%20COVID-19_web.pdf
Jewell BL, Mudimu E, Stover J, et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. Lancet HIV 2020; 7(9):e629–e640. doi: 10.1016/S2352-3018(20)30211-3
Stover J, Kelly SL, Mudimu E, et al. The risks and benefits of providing HIV services during the COVID-19 pandemic. medRxiv. March 1, 2021. Accessed July 18, 2021. https://www.medrxiv.org/content/10.1101/2021.03.01.21252663v2.full.pdf+html doi: https://doi.org/10.1101/2021.03.01.21252663
World Health Organization Publications. Maintaining essential health services: operational guidance for the COVID-19 context interim guidance. June 2020. Accessed July 18, 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-essential-health-services-2020.1