Understanding the impact of interruptions to HIV services during the COVID-19 pandemic : A modelling study
© 2020 The Authors..
BACKGROUND: There is concern that the COVID-19 pandemic could severely disrupt HIV services in sub-Saharan Africa. However, it is difficult to determine priorities for maintaining different elements of existing HIV services given widespread uncertainty.
METHODS: We explore the impact of disruptions on HIV outcomes in South Africa, Malawi, Zimbabwe, and Uganda using a mathematical model, examine how impact is affected by model assumptions, and compare potential HIV deaths to those that may be caused by COVID-19 in the same settings.
FINDINGS: The most important determinant of HIV-related mortality is an interruption to antiretroviral treatment (ART) supply. A three-month interruption for 40% of those on ART could cause a similar number of additional deaths as those that might be saved from COVID-19 through social distancing. An interruption for more than 6-90% of individuals on ART for nine months could cause the number of HIV deaths to exceed the number of COVID-19 deaths, depending on the COVID-19 projection. However, if ART supply is maintained, but new treatment, voluntary medical male circumcision, and pre-exposure prophylaxis initiations cease for 3 months and condom use is reduced, increases in HIV deaths would be limited to <2% over five years, although this could still be accompanied by a 7% increase in new HIV infections.
INTERPRETATION: HIV deaths could increase substantially during the COVID-19 pandemic under reasonable worst-case assumptions about interruptions to HIV services. It is a priority in high-burden countries to ensure continuity of ART during the pandemic.
FUNDING: Bill & Melinda Gates Foundation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
EClinicalMedicine - 26(2020) vom: 23. Sept., Seite 100483 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jewell, Britta L [VerfasserIn] |
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| Links: |
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| Themen: |
Antiretroviral therapy |
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| Anmerkungen: |
Date Revised 17.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.eclinm.2020.100483 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM316580864 |
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| 100 | 1 | |a Jewell, Britta L |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Understanding the impact of interruptions to HIV services during the COVID-19 pandemic |b A modelling study |
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| 500 | |a Date Revised 17.04.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2020 The Authors. | ||
| 520 | |a BACKGROUND: There is concern that the COVID-19 pandemic could severely disrupt HIV services in sub-Saharan Africa. However, it is difficult to determine priorities for maintaining different elements of existing HIV services given widespread uncertainty | ||
| 520 | |a METHODS: We explore the impact of disruptions on HIV outcomes in South Africa, Malawi, Zimbabwe, and Uganda using a mathematical model, examine how impact is affected by model assumptions, and compare potential HIV deaths to those that may be caused by COVID-19 in the same settings | ||
| 520 | |a FINDINGS: The most important determinant of HIV-related mortality is an interruption to antiretroviral treatment (ART) supply. A three-month interruption for 40% of those on ART could cause a similar number of additional deaths as those that might be saved from COVID-19 through social distancing. An interruption for more than 6-90% of individuals on ART for nine months could cause the number of HIV deaths to exceed the number of COVID-19 deaths, depending on the COVID-19 projection. However, if ART supply is maintained, but new treatment, voluntary medical male circumcision, and pre-exposure prophylaxis initiations cease for 3 months and condom use is reduced, increases in HIV deaths would be limited to <2% over five years, although this could still be accompanied by a 7% increase in new HIV infections | ||
| 520 | |a INTERPRETATION: HIV deaths could increase substantially during the COVID-19 pandemic under reasonable worst-case assumptions about interruptions to HIV services. It is a priority in high-burden countries to ensure continuity of ART during the pandemic | ||
| 520 | |a FUNDING: Bill & Melinda Gates Foundation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antiretroviral therapy | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Mathematical modelling | |
| 700 | 1 | |a Smith, Jennifer A |e verfasserin |4 aut | |
| 700 | 1 | |a Hallett, Timothy B |e verfasserin |4 aut | |
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