Policymakers should focus on retaining an uninterrupted supply of ART drugs during the Covid-19 pandemic to mitigate against deaths of HIV Patients.
Findings from a study published in the 7th Volume of the Lancet in September 2020, have found that a 6-month interruption of supply of antiretroviral therapy (ART) drugs across 50 per cent of the population of people living with Human Immunodeficiency Virus (HIV) who are on treatment would be expected to lead to a 1•63 times ( range 1•39–1•87) increase in HIV-related deaths over 1 year.
According to the study, this increase amounts to a median excess of HIV deaths, across all model estimates, of 296 000 (range 229, 023–420, 000) if such a high level of disruption were to occur.
Another finding from the study, titled “Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models”, is that although an interruption in the supply of ART drugs would have the largest impact of any potential disruptions, effects of poorer clinical care due to overstretched health facilities, interruptions of supply of other drugs such as cotrimoxazole, and suspension of HIV testing would all have a substantial effect on population-level mortality.
The scientists chose to study the effects of disruptions to 50 per cent of affected populations. The aim was to show the areas that are most susceptible to disruption among the various services that form part of most countries’ national HIV responses and; they state that their results should not be taken as a prediction that disruption will be as extensive as has been estimated here.
Such an extensive disruption to ART access as estimated here seems unlikely unless, for example, a country’s supply of ART drugs is delayed in being dispatched from the factory or in transit.
On July 6th, 2020, the World Health Organisation (WHO) announced that 73 countries have warned that they are at risk of stock-outs of antiretroviral medicines as a result of the COVID-19 pandemic.
Further, as of July 29, 2020, the President’s Emergency Plan for AIDS Relief reported that the median delay in receiving ART drugs is 35 days for adults and 29 days for children. 21 deliveries of orders for antiretrovirals are delayed because most manufacturers are based in India (which has been under lockdown in response to COVID-19); as well as transport challenges.
“Interruption to condom supplies and peer education would make populations more susceptible to increases in HIV incidence, although physical distancing measures could lead to reductions in risky sexual behaviour (up to 1•19 times increase in new HIV infections over 1 year if 50 per cent of people are affected),” the scientists further find.
HIV remains highly prevalent in sub-Saharan Africa with over 25•7 million (uncertainty range 22•2– 29•5) people estimated to be living with HIV in the region in 2018, that is, two years ago.
The scientists assert that there has been concern from people regarding possible disruptions in HIV programmes due to COVID-19 because they could affect HIV-related mortality and new infections.
A survey of people living with HIV run by the Human Sciences Research Council in South Africa through a social media platform, which the study has not clarified, found that 13 per cent of people said they did not have access to their chronic medication during lockdown.
According to the researchers, governments, donors, suppliers, and communities should focus on maintaining uninterrupted supply of ART drugs for people with HIV to avoid additional HIV-related deaths. Causes of such disruption could include COVID-19- related morbidity and mortality, clinic closures or reduced service availability, and physical distancing and other measures put in place to combat the virus spread.
Disruption to delivery of health care in SSA settings caused by COVID-19 could lead to adverse consequences for the health of people beyond those from COVID-19 itself.
Causes of such disruption could include COVID-19- related morbidity and mortality, clinic closures or reduced service availability, and physical distancing and other measures put in place to combat the virus spread.
