Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda.
Department of Medicine, Makerere University, Kampala, Uganda.
PLoS One. 2023 Aug 10;18(8):e0289000. doi: 10.1371/journal.pone.0289000. eCollection 2023.
In Uganda, COVID-19 lockdown policies curbed the spread of SARS-CoV-2, but their effect on HIV care is poorly understood.
We examined the effects of COVID-19 lockdown policies on ART initiation, missed visits, and viral suppression in Uganda.
We conducted a time series analysis using data from a dynamic cohort of persons with HIV enrolled between March 2017 and September 2021 at HIV clinics in Masaka and Mbarara Regional Referral Hospitals in Southwestern Uganda. Poisson and fractional probit regression were used to predict expected monthly antiretroviral therapy initiations, missed visits, and viral suppression based on pre-lockdown trends. Observed and expected trends were compared across three policy periods: April 2020-September 2021 (overall), April-May 2020 (1st lockdown), and June-August 2021 (2nd lockdown).
We enrolled 7071 Persons living with HIV (PWH) (nMasaka = 4150; nMbarara = 2921). Average ART duration was 34 and 30 months in Masaka and Mbarara, respectively. During the 18-month post-lockdown period, monthly ART initiations were lower than expected in both Masaka (51 versus 63 visits; a decrease of 12 [95% CI: -2, 31] visits) and Mbarara (42 versus 55 visits; a decrase of 13 [95% CI: 0, 27] visits). Proportion of missed visits was moderately higher than expected post-lockdown in Masaka (10% versus 7%; 4% [95% CI: 1%, 7%] absolute increase), but not in Mbarara (13% versus 13%; 0% [95% CI: -4%, 6%] absolute decrease). Viral suppression rates were moderate-to-high in Masaka (64.7%) and Mbarara (92.5%) pre-lockdown and remained steady throughout the post-lockdown period.
The COVID-19 lockdown in Uganda was associated with reductions in ART initiation, with minimal effects on retention and viral suppression, indicating a resilient HIV care system.
在乌干达，COVID-19 封锁政策遏制了 SARS-CoV-2 的传播，但它们对 HIV 护理的影响知之甚少。
我们研究了 COVID-19 封锁政策对乌干达开始接受抗逆转录病毒治疗（ART）、错过就诊和病毒抑制的影响。
我们使用了 2017 年 3 月至 2021 年 9 月期间在乌干达西南部马萨卡和姆巴拉拉地区转诊医院的 HIV 诊所招募的动态 HIV 感染者队列的数据，进行了时间序列分析。我们使用泊松和分数概率回归，根据封锁前的趋势预测每月抗逆转录病毒治疗启动、错过就诊和病毒抑制的预期值。根据三个政策期，比较了观察到的和预期的趋势：2020 年 4 月至 2021 年 9 月（整体）、2020 年 4 月至 5 月（第一封锁期）和 2021 年 6 月至 8 月（第二封锁期）。
我们纳入了 7071 名 HIV 感染者（PWH）（nMasaka = 4150；nMbarara = 2921）。马萨卡和姆巴拉拉的平均 ART 持续时间分别为 34 个月和 30 个月。在封锁后的 18 个月期间，马萨卡和姆巴拉拉的每月 ART 启动率均低于预期，分别为 51 次就诊（下降 12 次就诊[95%CI：-2，31]）和 42 次就诊（下降 13 次就诊[95%CI：0，27]）。封锁后，马萨卡的错过就诊比例略高于预期（10%，而不是 7%；增加 4%[95%CI：1%，7%]），而姆巴拉拉则没有（13%，而不是 13%；绝对减少 0%[95%CI：-4%，6%]）。马萨卡和姆巴拉拉的病毒抑制率在封锁前均为中高度（分别为 64.7%和 92.5%），并在整个封锁后期间保持稳定。
乌干达的 COVID-19 封锁与 ART 启动减少有关，但对保留和病毒抑制的影响很小，表明其 HIV 护理系统具有弹性。
