Shah Gulzar H, Etheredge Gina D, Smallwood Stacy W, Maluantesa Lievain, Waterfield Kristie C, Ikhile Osaremhen, Ditekemena John, Engetele Elodie, Ayangunna Elizabeth, Mulenga Astrid, Bossiky Bernard
Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, United States of America.
FHI 360, Washington, United States of America.
South Afr J HIV Med. 2022 Oct 28;23(1):1421. doi: 10.4102/sajhivmed.v23i1.1421. eCollection 2022.
The coronavirus disease 2019 (COVID-19) pandemic resulted in unique programmatic opportunities to test hypotheses related to the initiation of antiretroviral treatment (ART) and viral load (VL) suppression during a global health crisis, which would not otherwise have been possible.
To generate practice-relevant evidence on the impact of initiating ART pre-COVID-19 versus during the COVID-19 pandemic on HIV VL.
Logistic regression was performed on data covering 6596 persons with HIV whose VL data were available, out of 36 585 persons who were initiated on ART between 01 April 2019 and 30 March 2021.
After controlling for covariates such as age, gender, duration on ART, tuberculosis status at the time of the last visit, and rural vs urban status, the odds of having a VL < 1000 copies/mL were significantly higher for clients who started ART during the COVID-19 pandemic than the year before COVID-19 (adjusted odds ratio [AOR]: 2.50; confidence interval [CI]: 1.55-4.01; < 0.001). Odds of having a VL < 1000 copies/mL were also significantly higher among female participants than male (AOR: 1.23; CI: 1.02-1.48), among patients attending rural clinics compared to those attending urban clinics (AOR: 1.83; CI: 1.47-2.28), and in clients who were 15 years or older at the time of their last visit (AOR: 1.50; CI: 1.07-2.11).
Viral loads did not deteriorate despite pandemic-induced changes in HIV services such as the expansion of multi-month dispensing (MMD), which may have played a protective role regardless of the general negative impacts of response to the COVID-19 crises on communities and individuals.
This research capitalises on the natural experiment of COVID-19-related changes in HIV services and provides new practice-relevant research evidence.
2019年冠状病毒病（COVID-19）大流行带来了独特的项目机会，可在全球卫生危机期间检验与启动抗逆转录病毒治疗（ART）及病毒载量（VL）抑制相关的假设，而这在其他情况下是不可能实现的。
获取与实践相关的证据，以了解在COVID-19大流行前与大流行期间启动ART对HIV病毒载量的影响。
对2019年4月1日至2021年3月30日期间开始接受ART治疗的36585人中6596名有HIV病毒载量数据的人的数据进行逻辑回归分析。
在控制年龄、性别、ART治疗时长、上次就诊时的结核病状况以及城乡状况等协变量后，在COVID-19大流行期间开始接受ART治疗的患者病毒载量<1000拷贝/毫升的几率显著高于COVID-19之前的年份（调整后的优势比[AOR]：2.50；置信区间[CI]：1.55 - 4.01；P<0.001）。女性参与者病毒载量<1000拷贝/毫升的几率也显著高于男性（AOR：1.23；CI：1.02 - 1.48），在农村诊所就诊的患者相比在城市诊所就诊的患者（AOR：1.83；CI：1.47 - 2.28），以及上次就诊时年龄在15岁及以上的患者（AOR：1.50；CI：1.07 - 2.11）。
尽管大流行导致HIV服务发生了变化，如多月份配药（MMD）的扩大，但病毒载量并未恶化，这可能起到了保护作用，尽管应对COVID-19危机对社区和个人总体上有负面影响。
本研究利用了与COVID-19相关的HIV服务变化这一自然实验，并提供了与实践相关的新研究证据。
