Impact of COVID-19 on the HIV care continuum in Asia: Insights from people living with HIV, key populations, and HIV healthcare providers

Chien-Ching Hung; Sumita Banerjee; Ishwar Gilada; Kimberly Green; Yoji Inoue; Adeeba Kamarulzaman; Kate Leyritana; Nittaya Phanuphak; Timothy Wong; TinHung Wong; Shikha Singh; Jun Yong Choi

doi:10.1371/journal.pone.0270831

Impact of COVID-19 on the HIV care continuum in Asia: Insights from people living with HIV, key populations, and HIV healthcare providers

PLoS One. 2022 Jul 20;17(7):e0270831. doi: 10.1371/journal.pone.0270831. eCollection 2022.

Authors

Chien-Ching Hung^{1

2}, Sumita Banerjee³, Ishwar Gilada⁴, Kimberly Green⁵, Yoji Inoue⁶, Adeeba Kamarulzaman⁷, Kate Leyritana⁸, Nittaya Phanuphak⁹, Timothy Wong¹⁰, TinHung Wong¹¹, Shikha Singh¹², Jun Yong Choi¹³

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
² Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
³ Action for AIDS, Singapore, Singapore.
⁴ AIDS Society of India, Mumbai, India.
⁵ PATH, Vietnam.
⁶ Juntendo University, Tokyo, Japan.
⁷ Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁸ Sustained Health Initiatives of the Philippines, SHIP, Metro Manila, Philippines.
⁹ Institute of HIV Research and Innovation, Bangkok, Thailand.
¹⁰ Hong Kong AIDS Foundation, Hong Kong SAR, China.
¹¹ Gilead Sciences, Hong Kong SAR, China.
¹² Cerner Enviza, Singapore, Singapore.
¹³ Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

Abstract

Background: The COVID-19 pandemic has threatened continued access to public health services worldwide, including HIV prevention and care. This study aimed to evaluate the impact of the COVID-19 pandemic on HIV service access and delivery in the Asia region.

Methods: A descriptive, cross-sectional, online study, conducted between October-November 2020, assessed the impact of COVID-19 on HIV prevention and care among people living with HIV (PLHIV), key populations (KPs), and healthcare providers (HCPs). The study populations were recruited across ten Asian countries/territories, covering Hong Kong, India, Japan, Malaysia, Philippines, Singapore, Korea, Taiwan, Thailand, and Vietnam.

Results: Across the region, 702 PLHIV, 551 KPs, and 145 HCPs were recruited. Both PLHIV and KPs reported decreased or had yet to visit hospitals/clinics (PLHIV: 35.9%; KPs: 57.5%), reduced HIV RNA viral load testing (21.9%; 47.3%), and interruptions in antiretroviral therapy (ART) (22.3%) or decreased/complete stop of HIV prevention medication consumption (40.9%). Travel constraints (40.6%), financial issues (28.9%), and not receiving prescription refills (26.9%) were common reasons for interrupted ART access, whereas reduced engagements in behaviours that could increase the risks of HIV acquisition and transmission (57.7%), travel constraints (41.8%), and less hospital/clinic visits (36.7%) underlie the disruptions in HIV preventive medications. Decreased visits from PLHIV/KPs and rescheduled appointments due to clinic closure were respectively reported by 50.7%-52.1% and 15.6%-17.0% of HCPs; 43.6%-61.9% observed decreased ART/preventive medication refills. Although 85.0% of HCPs adopted telemedicine to deliver HIV care services, 56.4%-64.1% of PLHIV/KPs were not using telehealth services.

Conclusions: The COVID-19 pandemic substantially disrupted HIV prevention to care continuum in Asia at the time of the study. The findings highlighted differences in HIV prevention to care continuum via telehealth services utilisation by PLHIV, KPs, and HCPs. Efforts are needed to optimise infrastructure and adapt systems for continued HIV care with minimal disruptions during health emergency crises.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome* / epidemiology
COVID-19* / epidemiology
Continuity of Patient Care
Cross-Sectional Studies
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Health Personnel
Hong Kong
Humans
Pandemics

Grants and funding

This study was funded by Gilead Sciences (grant number: not applicable). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Cerner Enviza received funding from Gilead Sciences for the conduct of the study, data collection and analysis, and preparation of the manuscript.