Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
J Int AIDS Soc. 2022 Jul;25(7):e25960. doi: 10.1002/jia2.25960.
INTRODUCTION: The COVID-19 pandemic has threatened to diminish gains in HIV epidemic control and impacts are likely most profound among key populations in resource-limited settings. We aimed to understand the pandemic's impact on HIV-related service utilization among men who have sex with men (MSM) and people who inject drugs (PWID) across India. METHODS: Beginning in 2013, we established integrated care centres (ICCs) which provide HIV preventive and treatment services to MSM and PWID across 15 Indian sites. We examined utilization patterns for an 18-month period covering 2 months preceding the pandemic (January-February 2020) and over the first and second COVID-19 waves in India (March 2020-June 2021). We assessed: (1) unique clients accessing any ICC service, (2) ICC services provided, (3) unique clients tested for HIV and (4) HIV diagnoses and test positivity. Among an established cohort of PWID/MSM living with HIV (PLHIV), we administered a survey on the pandemic's impact on HIV care and treatment (June-August 2020). RESULTS: Overall, 13,854 unique clients visited an ICC from January 2020 to June 2021. In January/February 2020, the average monthly number of clients was 3761. Compared to pre-pandemic levels, the number of clients receiving services declined sharply in March 2020, dropping to 25% of pre-pandemic levels in April/May 2020 (first wave), followed by a slow rebound until April/May 2021 (second wave), when there was a 57% decline. HIV testing followed a similar trajectory. HIV test positivity changed over time, declining in the first wave and reaching its nadir around July 2020 at ∼50% of pre-pandemic levels. Positivity then increased steadily, eventually becoming higher than pre-pandemic periods. The second wave was associated with a decline in positivity for MSM but was relatively unchanged for PWID. Among 1650 PLHIV surveyed, 52% of PWID and 45% of MSM reported the pandemic impacted their ability to see an HIV provider. MSM had barriers accessing sexually transmitted infection testing and partner HIV testing. CONCLUSIONS: The COVID-19 pandemic led to significant decreases in HIV-related service utilization among key populations in India. This presents an opportunity for increased transmission and patients presenting with advanced disease among groups already disproportionately impacted by HIV.
简介：COVID-19 大流行威胁到艾滋病毒流行控制方面的进展，在资源有限的环境下的重点人群中，其影响可能最为深远。我们旨在了解该大流行对印度男男性行为者（MSM）和注射吸毒者（PWID）与艾滋病毒相关的服务利用情况的影响。
方法：自 2013 年以来，我们在印度 15 个地点建立了综合护理中心（ICC），为 MSM 和 PWID 提供艾滋病毒预防和治疗服务。我们检查了涵盖大流行前 2 个月（2020 年 1 月至 2 月）和印度第一波和第二波 COVID-19 期间（2020 年 3 月至 2021 年 6 月）的 18 个月的利用模式。我们评估了：（1）访问任何 ICC 服务的独特客户数量，（2）提供的 ICC 服务，（3）接受 HIV 检测的独特客户数量，以及（4）HIV 诊断和检测阳性率。在感染艾滋病毒的已建立的 PWID/MSM 患者队列中，我们于 2020 年 6 月至 8 月进行了一项关于大流行对艾滋病毒护理和治疗影响的调查。
结果：总体而言，从 2020 年 1 月至 2021 年 6 月，共有 13854 名独特的客户访问了 ICC。在 2020 年 1 月/2 月，每月客户平均数量为 3761。与大流行前水平相比，2020 年 3 月服务客户数量急剧下降，到 2020 年 4 月/5 月（第一波）降至大流行前水平的 25%，随后缓慢反弹，直到 2021 年 4 月/5 月（第二波），下降了 57%。HIV 检测也呈现出类似的轨迹。HIV 检测阳性率随时间而变化，第一波下降，到 2020 年 7 月左右达到大流行前水平的 50%。然后阳性率稳步上升，最终高于大流行前时期。第二波与 MSM 的阳性率下降有关，但 PWID 的阳性率相对不变。在接受调查的 1650 名 PLHIV 中，52%的 PWID 和 45%的 MSM 报告说，大流行影响了他们见到 HIV 提供者的能力。MSM 在获得性传播感染检测和伴侣 HIV 检测方面存在障碍。
结论：COVID-19 大流行导致印度重点人群与艾滋病毒相关的服务利用显著减少。这为已经受到艾滋病毒严重影响的群体中传播和患者出现晚期疾病提供了机会。
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