Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
YR Gaitonde Center for AIDS Research and Education, Chennai, India.
J Int AIDS Soc. 2021 Oct;24 Suppl 6(Suppl 6):e25800. doi: 10.1002/jia2.25800.
There are limited data on the impact of COVID-19-associated disruptions and novel HIV service delivery strategies among key populations (KPs) in low- and middle-income countries. In March 2020, in response to COVID-19, the Government of India revised HIV service delivery policies to include community antiretroviral therapy (ART) distribution and multi-month dispensing (MMD) of ART for all people living with HIV (PLHIV).
To assess the acceptability of these adaptations and impact of the pandemic among KPs, we conducted focus groups in November-December 2020 with purposively sampled men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were conducted. Topics included HIV service access, risk behaviours, economic security and feedback to ensure service continuity. Inductive coding identified themes across topics.
Forty-four individuals aged 20-49 years participated in discussions (13 MSM; 16 FSW; and 15 TGW). Twenty-four participants self-identified as living with HIV. People not living with HIV reported challenges in accessing HIV antibody testing at hospitals due to travel restrictions and fear of contracting COVID-19. Participants accessed HIV antibody testing using transportation arranged by community-based organizations after lockdowns eased. PLHIV reported uninterrupted ART refills and generally consistent adherence; however, there were experiences of delayed CD4 and HIV RNA testing. Participants shared appreciation for MMD as it saved time, money, and reduced exposure to COVID-19. Participants expressed gratitude for home deliveries which enabled ART access, yet shared concerns about home-based services causing confidentiality breaches with family/neighbours. Participants voiced preferences for community-based service provision due to proximity, convenient hours, and welcoming environments compared to public hospitals. Other requests included support for income, employment, nutrient-rich food and more accessible mental health, HIV, and other health services.
COVID-19 restrictions had a greater impact on access to HIV antibody, CD4, and RNA testing services compared to ART access. High acceptance of MMD and community-based services support the continued role of differentiated service delivery models to improve KP access to HIV antibody, CD4, RNA testing services, convenient ART retrieval, and integrated services beyond HIV, which may be critical for survival and wellbeing.
在中低收入国家，针对新型冠状病毒肺炎（COVID-19）相关干扰和新型艾滋病毒服务提供策略对重点人群（KPs）的影响，相关数据有限。2020 年 3 月，印度政府针对 COVID-19 修订了艾滋病毒服务提供政策，包括为所有艾滋病毒感染者（PLHIV）提供社区抗逆转录病毒治疗（ART）和 ART 的多剂量配给（MMD）。
为了评估这些调整措施的可接受性以及大流行对 KPs 的影响，我们于 2020 年 11 月至 12 月在泰伦加纳邦和马哈拉施特拉邦与有针对性地抽样的男男性接触者（MSM）、女性性工作者（FSW）和跨性别女性（TGW）进行了焦点小组讨论。共进行了 7 次讨论。主题包括艾滋病毒服务的获取、风险行为、经济安全和反馈，以确保服务的连续性。归纳编码确定了主题之间的主题。
44 名 20-49 岁的参与者参加了讨论（13 名 MSM；16 名 FSW；15 名 TGW）。24 名参与者自我认定为 HIV 感染者。未感染 HIV 的人报告说，由于旅行限制和担心感染 COVID-19，他们在医院接受艾滋病毒抗体检测时遇到了困难。在封锁放松后，参与者利用社区组织安排的交通工具接受了艾滋病毒抗体检测。PLHIV 报告说 ART 补充剂没有中断，并且普遍保持一致的依从性；但是，CD4 和 HIV RNA 检测有延迟。参与者对 MMD 表示赞赏，因为它节省了时间、金钱并减少了 COVID-19 的暴露。参与者对上门服务表示感谢，这使他们能够获得 ART，但也对家庭/邻居可能导致保密协议泄露表示担忧。与公立医院相比，参与者表达了对社区为基础服务的偏好，因为这些服务提供了便利性、方便的时间和欢迎的环境。其他要求包括对收入、就业、营养丰富的食物以及更方便获得的心理健康、艾滋病毒和其他健康服务的支持。
与 ART 获得相比，COVID-19 限制对艾滋病毒抗体、CD4 和 RNA 检测服务的获取影响更大。对 MMD 和社区为基础服务的高度认可支持继续实施差异化服务提供模式，以改善 KP 获取艾滋病毒抗体、CD4、RNA 检测服务、方便获取 ART 以及超越 HIV 的综合服务，这对生存和福祉可能至关重要。
