Maphosa Thulani, Phoso Malocho, Makonokaya Lucky, Kalitera Louiser, Machekano Rhoderick, Maida Alice, Chamanga Rachel Kanyenda, Woelk Godfrey
Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.
PLOS Glob Public Health. 2024 Sep 5;4(9):e0003665. doi: 10.1371/journal.pgph.0003665. eCollection 2024.
The global disruption caused by the SARS-CoV-2 pandemic profoundly affected healthcare systems, particularly impacting People Living with Human Immunodeficiency Virus (PLHIV). This study investigated the repercussions of SARS-CoV-2 infection on access to human immunodeficiency virus (HIV) care and antiretroviral therapy (ARV) in Malawi, emphasizing the critical need to sustain uninterrupted HIV services during health crises. Employing mobile phone-based syndromic surveillance, this study assessed the influence of SARS-CoV-2 on healthcare access for PLHIV across nine districts supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). Telephone-based interviews were conducted to analyze demographic factors, challenges encountered in accessing HIV services, and adherence to ARV medication, illuminating the pandemic's effects on ARV uptake. The findings revealed that approximately 3.9% (n = 852) of 21981 participants faced obstacles in accessing crucial HIV services during the pandemic, resulting in approximately 1.2% (n = 270) reporting multiple missed doses of ARV medication in a particular month. After adjusting for various variables, males exhibited a higher likelihood of service inaccessibility than females (Adjusted Odds Ratio [AOR] = 1.39, 95% CI: 1.20-1.60, p < 0.001). Age also played a significant role, with individuals aged 35-49 years and those aged 50 years or older demonstrating reduced odds of service failure compared with the reference group aged 18-34 years. Only a small proportion of PLHIV reported disruption in HIV care access, which may be because Malawi did not initiate stringent travel restrictions during the SARS-CoV-2 pandemic. Nonetheless, enduring challenges have been observed in retaining younger PLHIV and men in HIV-care settings. Thus, targeted strategies are imperative for effectively engaging and sustaining these populations in HIV care during and after health crises.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行造成的全球混乱对医疗系统产生了深远影响，尤其对感染人类免疫缺陷病毒（HIV）的人群（PLHIV）产生了冲击。本研究调查了SARS-CoV-2感染对马拉维获得人类免疫缺陷病毒（HIV）护理和抗逆转录病毒疗法（ARV）的影响，强调了在健康危机期间维持不间断HIV服务的迫切需求。本研究采用基于手机的症状监测，评估了SARS-CoV-2对伊丽莎白·格拉泽儿科艾滋病基金会（EGPAF）支持的九个地区PLHIV获得医疗服务的影响。通过电话访谈分析了人口统计学因素、获得HIV服务时遇到的挑战以及对抗逆转录病毒药物的依从性，阐明了大流行对ARV使用的影响。研究结果显示，在21981名参与者中，约3.9%（n = 852）在大流行期间获得关键HIV服务时面临障碍，导致约1.2%（n = 270）的人报告在特定月份多次错过抗逆转录病毒药物剂量。在对各种变量进行调整后，男性比女性更有可能无法获得服务（调整后的优势比[AOR]=1.39，95%置信区间：1.20 - 1.60，p<0.001）。年龄也起到了重要作用，与18 - 34岁的参考组相比，35 - 49岁的个体和50岁及以上的个体服务失败的几率降低。只有一小部分PLHIV报告在获得HIV护理方面受到干扰，这可能是因为马拉维在SARS-CoV-2大流行期间未实施严格的旅行限制。尽管如此，在让年轻的PLHIV和男性留在HIV护理环境方面仍存在持久挑战。因此，在健康危机期间及之后，采取有针对性的策略对于有效吸引和维持这些人群接受HIV护理至关重要。
