Abstract
BackgroundThere 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.MethodsWe 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.FindingsThe 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.InterpretationHIV 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.FundingBill & Melinda Gates Foundation.
Highlights
The COVID-19 pandemic poses a great threat to the health of populations worldwide [3]
This may be detrimental for countries in sub-Saharan Africa that suffer from high burdens of other diseases, including HIV, tuberculosis, and malaria [4]
A wide-spread and long-lasting interruption to antiretroviral treatment (ART) supply could cause additional deaths on the same order of magnitude as those which could be saved by interventions to mitigate the COVID-19 epidemic or match the deaths resulting from the COVID-19 epidemic itself
Summary
The COVID-19 pandemic poses a great threat to the health of populations worldwide [3]. In addition to the direct health impact of the COVID-19 pandemic itself, there may be a detrimental impact on service provision for other health conditions due to increasing demands on overall health service capacity, interruptions to supply of medicines, or funding shortages. This may be detrimental for countries in sub-Saharan Africa that suffer from high burdens of other diseases, including HIV, tuberculosis, and malaria [4]. 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.
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