Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by Covid-19

Results from multiple mathematical models

Datos Bibliográficos

ID23320237
AutoresBritta L Jewell (0000-0003-4275-8509, Imperial College London), Edinah Mudimu (0000-0002-5479-9255, University of South Africa), John Stover (0000-0001-7236-1989, Avenir Health), Debra ten Brink (0000-0001-5938-6970, Burnet Institute), Andrew N Phillips (0000-0003-2384-4807, Health Data Research UK, autor de correspondencia), Jennifer A Smith (0000-0002-3575-5468), Jennifer Smith (0000-0001-6825-7118, Imperial College London), Rowan Martin‐Hughes (0000-0002-3724-2412, Burnet Institute), Rowan Martin-Hughes, Yu Teng (Avenir Health), Robert Glaubius (0000-0002-4936-0264, Avenir Health), Severin Guy Mahiane (Avenir Health), Loveleen Bansi‐Matharu (0000-0002-0233-7622, University College London), Loveleen Bansi-Matharu, Isaac Taramusi (0000-0002-5871-2874, National Aids Council), Newton Chagoma (0000-0003-0752-1696, National AIDS Commission), Michelle Morrison (Gates Foundation), Meg Doherty (0000-0003-2986-7129, World Health Organization), Kimberly Marsh (0000-0002-2721-1639, Joint United Nations Programme on HIV/AIDS), Anna Bershteyn (0000-0002-6604-7093, New York University), Timothy B Hallett (0000-0002-9681-0424, Imperial College London), Sherrie L Kelly (0000-0002-6232-5586, Burnet Institute)
Año2020
Volumen7
Número9
Páginase629-e640
Fecha de publicación2020-09-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaThe Lancet HIV (JOURNAL)
Identificadores de la revistaISSN: 2352-3018 • E-ISSN: 2405-4704
EditorialElsevier BV (PUBLISHER)
DOI10.1016/s2352-3018(20)30211-3
PMID32771089
OpenAlexW3047456007
IdiomaEN
Citas recibidas69
Referencias citadas15

BACKGROUND: The COVID-19 pandemic could lead to disruptions to provision of HIV services for people living with HIV and those at risk of acquiring HIV in sub-Saharan Africa, where UNAIDS estimated that more than two-thirds of the approximately 38 million people living with HIV resided in 2018. We aimed to predict the potential effects of such disruptions on HIV-related deaths and new infections in sub-Saharan Africa. METHODS: In this modelling study, we used five well described models of HIV epidemics (Goals, Optima HIV, HIV Synthesis, an Imperial College London model, and Epidemiological MODeling software [EMOD]) to estimate the effect of various potential disruptions to HIV prevention, testing, and treatment services on HIV-related deaths and new infections in sub-Saharan Africa lasting 6 months over 1 year from April 1, 2020. We considered scenarios in which disruptions affected 20%, 50%, and 100% of the population. FINDINGS: A 6-month interruption of supply of antiretroviral therapy (ART) drugs across 50% of the population of people living with HIV who are on treatment would be expected to lead to a 1·63 times (median across models; range 1·39-1·87) increase in HIV-related deaths over a 1-year period compared with no disruption. In sub-Saharan Africa, this increase amounts to a median excess of HIV deaths, across all model estimates, of 296 000 (range 229 023-420 000) if such a high level of disruption occurred. Interruption of ART would increase mother-to-child transmission of HIV by approximately 1·6 times. Although an interruption in the supply of ART drugs would have the largest impact of any potential disruptions, effects of poorer clinical care due to overstretched health facilities, interruptions of supply of other drugs such as co-trimoxazole, and suspension of HIV testing would all have a substantial effect on population-level mortality (up to a 1·06 times increase in HIV-related deaths over a 1-year period due to disruptions affecting 50% of the population compared with no disruption). Interruption to condom supplies and peer education would make populations more susceptible to increases in HIV incidence, although physical distancing measures could lead to reductions in risky sexual behaviour (up to 1·19 times increase in new HIV infections over a 1-year period if 50% of people are affected). INTERPRETATION: During the COVID-19 pandemic, the primary priority for governments, donors, suppliers, and communities should focus on maintaining uninterrupted supply of ART drugs for people with HIV to avoid additional HIV-related deaths. The provision of other HIV prevention measures is also important to prevent any increase in HIV incidence. FUNDING: Bill & Melinda Gates Foundation.

2019-20 coronavirus outbreak · Coronavirus disease 2019 (COVID-19) · Development economics · Economics · Geography · Human immunodeficiency virus (HIV) · Outbreak · Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) · COVID-19 epidemiological studies · HIV/AIDS Research and Interventions · Internal Medicine · Medicine · Viral Infections and Outbreaks Research · Virology