Client and provider experiences with, and approaches to sustain HIV care during the COVID-19 pandemic restrictions at two public hospitals in southwestern Uganda

Abstract

IntroductionThe COVID-19 pandemic had far-reaching consequences on global health systems, disrupting the delivery of routine healthcare services, and posing new challenges to ongoing disease control efforts. In Uganda, where HIV is endemic, the pandemic threatened to reverse the gains in the country’s HIV response over the past decade. In this study, we explored the effects of the COVID-19 pandemic on the HIV cascade, focusing on the impact of pandemic-related disruptions on retention in HIV care among Persons with HIV (PWH). We further highlighted the key challenges and opportunities for mitigating the adverse effects.MethodsQualitative data were collected from January 2022 to March 2022 using in-depth interviews with PWH (n = 20) and healthcare workers (n = 4) and key informant interviews (n = 6) with healthcare managers. The interviews explored current and previous experiences with HIV care services, including experiences of healthcare providers and managers delivering and PWH receiving HIV care amidst the COVID-19 restrictions and recovery period, strategies implemented to ensure continuity of services and barriers to implementing these strategies. We coded data in Dedoose software and analyzed using the thematic analysis.ResultsThe qualitative findings highlight the effects of the COVID-19 pandemic, including restricted access to HIV care points, sub-optimal clinical management of persons with HIV, loss of livelihoods, and interruptions in adherence. Adaptations to ensure continuity of care included leveraging community-based drug delivery strategies, phone call consultations, modification of clinic workspaces, and linkages to nearby health facilities. Barriers to these adaptations included the increased cost of services, psychological challenges, fear and anxiety surrounding COVID infection, access to treatment, survival, loss to follow-up with no information on patient referral, COVID infection among health workers, depletion of drug stocks due to multi-month scripting, shortage of Personal protective  equipment (PPE) supplies and other drugs.ConclusionThe COVID-19 pandemic had a significant impact on HIV care in Uganda, including reduced access to HIV care and support services, interruptions to ART adherence, and changes in HIV care delivery. Our findings highlight the barriers and enablers to HIV care delivery during the COVID-19 pandemic and lockdown and provide valuable lessons on efforts to mitigate interruptions in the future during periods of pandemics/lockdowns.