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HIV prevention and treatment in the era of COVID-19 in South Africa

Title
HIV prevention and treatment in the era of COVID-19 in South Africa
Presenter
Phyllis Chituku
Authors
P. Chituku * (1), V. Tshivase (2), Z. Kwinda (2), T. Chidarikire (3), Y. Pillay (1)
Institutions
(1) Clinton Health Access Initiative, COVID-19 Emergency Response, Pretoria, South Africa, (2) Clinton Health Access Initiative, HIV Prevention, Pretoria, South Africa, (3) National Department of Health, Hiv Prevention and Testing, Pretoria, South Africa

BACKGROUND: The COVID-19 pandemic overwhelmed health services and critically disrupted the routine provision of essential health services globally. When the World Health Organization declared COVID19 a public health emergency, the South African government in response to an increase in cases and to mitigate the spread of COVID19 implemented several measures to limit the spread of COVID-19, which unfortunately reduced the use of health services and affected continuity of care for people with TB, HIV and other chronic diseases like diabetes and hypertension. This study seeks to assess the effect of COVID-19 on HIV prevention and treatment programs as well as on mortality.
METHODS: A retrospective mortality line-list review was conducted on COVID-19 deaths from 27th March to 28th February 2021 from all nine provinces in South Africa. Descriptive statistics were used to summarise mortality data reports from provinces. In addition, retrospective HIV testing and ART initiation data were extracted from the District Health Information System (DHIS) for the 2019-2021 period.
RESULTS: A review of DHIS data indicated a 1,1% decline of HIV tests done in 2020 compared with 2019. In 2021, there was a further decline in HIV testing of 35.4% compared to 2020. In 2019, 81.8% of those who tested positive were initiated on ART; however, the figure declined to 71,6% in 2020, rising marginally to 74,7% in 2021. COVID-19 mortality data shows that of the total 50 148 deaths reported during the review period, 4% were HIV positive patients and 58% were female. TB-HIV co-infection was reported in 13% of the HIV deaths, diabetes was reported in 24.2% of the HIV positive deaths, whilst a combination of HIV, diabetes and hypertension was reported in 13% of the deaths.
CONCLUSIONS: Lockdown measures impacted an already fragmented health system, including HIV testing and treatment services. Management of COVID-19 for patients with HIV is further complicated by co-morbidities such as hypertension and diabetes. Preparing for pandemics and having a resilient health system (especially the primary health care system) is vital to ensure continuity of care. In addition, the importance of designing health systems to treat patients with multi-morbidities should be prioritised.

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