COVID-19 disrupted HIV care for a majority of PLHIV: survey

Over 82 per cent of surveyed prescribers in India reported a decrease in frequency or delay of visits of PLHIV

The first cross-country pulse survey to evaluate the impact of the COVID-19 pandemic on access and delivery of HIV care in Asia Pacific shows that over 80 per cent of surveyed prescribers reported that there was a decrease in the frequency or delay of visits of people living with HIV (PLHIV) while about 46 per cent of at-risk population reported a decrease in frequency of taking HIV tests during COVID-19.

The survey titled “Impact of COVID-19 on access and delivery of HIV care in Asia Pacific” was conducted online, from October to mid-November 2020, in 10 countries/territories in Asia Pacific (Hong Kong, India, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam) by Kantar Health, funded by Gilead Sciences with the provision of guidance and support from the AIDS Society of India.

The survey was disseminated to local medical societies, HIV patient groups and care centers, with 1,265 respondents, comprising people living with HIV, at-risk population and HIV care prescribers, participating in the survey, including 96 from India.

This region has more than 5.8 million PLHIV and in 2019, 300,000 were newly infected and about 160,000 deaths were AIDS-related, as per data from the UN Joint Programme on HIV/AIDS (UNAIDS), 2020.

According to 2017 data for India, there are 2.1 million PLHIV; that year, 88,000 people were newly infected with HIV while 69,000 died from AIDS-related illnesses, according to an UNAIDS overview. According to a UNAIDS report released this May, disruption to HIV care could lead to thousands more deaths.

Commenting on the survey, Dr I. S. Gilada, President, AIDS Society of India, said, “The COVID-19 pandemic has had serious implications on the delivery of healthcare services in HIV across the region, whether in low or high-income countries. Despite proactive efforts by the National AIDS Control Organisation (NACO) to minimise the impact of disruption in medical services and delivery of ART, PLHIV and at-risk populations suffered a severe blow. Interruptions to access and delivery of care can negatively impact PLHIV and those at-risk of HIV, putting them at a higher risk of health complications. This survey is an indication of the critical gaps in access to testing, treatment and preventive care, and shines a light on areas that need to be strengthened to prepare for future public health emergencies or disruptions.”

Over 82 per cent of prescribers in India reported that there was a decrease in the frequency or delay of visits of PLHIV. An analysis of the responses in the survey provides additional insights into the disruptions caused by the COVID-19 pandemic:

• About 46 per cent of at-risk population reported a decrease in frequency of taking HIV tests during COVID-19. The main reasons for reduced testing were concerns of getting infected with COVID-19 (62 per cent) and travel restrictions imposed during the pandemic (46 per cent), as HIV tests were mostly only accessible at point-of-care.
• About 80 per cent of HIV care prescribers reported a decline in preventive prescriptions for at-risk population while more than 1 in 3 amongst the at-risk population reported that they had either decreased or stopped taking HIV preventive medicine. About 50 per cent of prescribers also reported a decline in prescribing refill antiretroviral medication to PLHIV. Travel restrictions and a change in high-risk behaviour emerged as some of the main reasons for the disruption in treatment.
• Almost 47 per cent of PLHIV and 37 per cent of those at-risk reported that they are concerned about getting antiretroviral medicines and preventive medication during the ongoing COVID-19 pandemic.

Telehealth is becoming a mode of delivery for HIV care during the COVID-19 pandemic. Amongst HIV care prescribers, almost 97 per cent use telehealth to consult with patients via telephone (85 per cent) or video (50 per cent), or to provide refill prescriptions (67 per cent). A majority of prescribers surveyed (76 per cent) expect an increase in telehealth adoption in the future as it offers convenience, allows them to reach more patients and reduces spread of illness. Amongst PLHIV and those at-risk, the most frequent type of telehealth service received from doctors were phone consultations (58 per cent).