China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China.
College of Health Science, Salale University, Fitche, Ethiopia.
BMJ Open. 2024 Nov 1;14(10):e084244. doi: 10.1136/bmjopen-2024-084244.
The study aimed to investigate the impact of COVID-19 on the cascade of HIV care for people living with HIV (PLHIV) in Ethiopia.
A retrospective longitudinal study.
The study was conducted in North Showa Zone, Ethiopia, from pre-COVID-19 (January 2018-December 2019) and during COVID-19 (January 2020-December 2021).
We identified 61901 records from 3925 PLHIV, of which 23 848 were recorded during the pandemic.
We investigated indicators from four stages of the HIV care cascade, including HIV screening and diagnosis, HIV care, HIV treatment and HIV disease progression, according to a WHO framework. The indicator changes were assessed with incidence rate ratios (IRRs).
For HIV screening and diagnosis, the monthly number of HIV tests experienced a 46% decline from 2520 to 1361 since the pandemic (IRR 0.553; 95% CI 0.546 to 0.561). For HIV care, the monthly number of consultations was reduced by 49.6% (from 1582 to 798) since the pandemic (IRR 0.591; 95% CI 0.581 to 0.601). Similarly, the monthly number of viral load tests was reduced by 42.8% (IRR 0.614; 95% CI 0.581 to 0.650). For HIV treatment, the number of antiretroviral therapy (ART) initiations was reduced by 27.8% and the number of ART adherence by 52.5% since the pandemic. For HIV disease progression, the monthly number of PLHIV achieving viral suppression was reduced by 61.6%, while HIV-related deaths doubled during the pandemic.
The study highlights pandemic-induced disruptions in the cascade of care for PLHIV. Targeted interventions are necessary to protect PLHIV in public health emergencies.
本研究旨在探讨 COVID-19 对埃塞俄比亚 HIV 感染者（PLHIV）的 HIV 护理连续体的影响。
回顾性纵向研究。
本研究在埃塞俄比亚北绍瓦地区进行，时间为 COVID-19 之前（2018 年 1 月至 2019 年 12 月）和 COVID-19 期间（2020 年 1 月至 2021 年 12 月）。
我们从 3925 名 PLHIV 中确定了 61901 条记录，其中 23848 条记录是在大流行期间记录的。
根据世界卫生组织（WHO）的框架，我们调查了 HIV 护理连续体四个阶段的指标，包括 HIV 筛查和诊断、HIV 护理、HIV 治疗和 HIV 疾病进展。用发病率比值（IRR）评估指标变化。
在 HIV 筛查和诊断方面，自疫情以来，HIV 检测的月检测次数下降了 46%，从 2520 次降至 1361 次（IRR 0.553；95%CI 0.546 至 0.561）。在 HIV 护理方面，自疫情以来，每月咨询次数减少了 49.6%（从 1582 次降至 798 次）（IRR 0.591；95%CI 0.581 至 0.601）。同样，每月病毒载量检测次数减少了 42.8%（IRR 0.614；95%CI 0.581 至 0.650）。在 HIV 治疗方面，自疫情以来，开始抗逆转录病毒治疗（ART）的人数减少了 27.8%，ART 依从性减少了 52.5%。在 HIV 疾病进展方面，每月达到病毒抑制的 PLHIV 人数减少了 61.6%，而 HIV 相关死亡人数在疫情期间增加了一倍。
本研究强调了大流行对 PLHIV 护理连续体的干扰。在公共卫生紧急情况下，需要采取有针对性的干预措施来保护 PLHIV。
