Effects of the COVID-19 Pandemic on ART Initiation and Access to HIV Viral Load Monitoring in Adults Living With HIV in West Africa: A Regression Discontinuity Analysis

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 96; no. 2; pp. 114 - 120
• Main Authors: Ben Farhat, Jihane, Tiendrebeogo, Thierry, Malateste, Karen, Poda, Armel, Minga, Albert, Messou, Eugène, Chenal, Henri, Ezechi, Oliver, Ofotokun, Igho, Ekouevi, Didier K, Bonnet, Fabrice, Barger, Diana, Jaquet, Antoine
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins Ovid Technologies 01-06-2024; Lippincott, Williams & Wilkins
• Subjects: Adult; Adults; Africa, Western - epidemiology; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Burkina Faso - epidemiology; Cote d'Ivoire - epidemiology; COVID-19; COVID-19 - epidemiology; Discontinuity; Epidemiology; Female; Health care; Health Services Accessibility; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; Human immunodeficiency virus; Humans; Life Sciences; Male; Middle Aged; Monitoring; Nigeria - epidemiology; Pandemics; Regression analysis; Santé publique et épidémiologie; SARS-CoV-2; Viral Load; Burkina Faso; Nigeria; Africa, Western; Cote d'Ivoire; West Africa
• ISSN: 1525-4135; 1944-7884; 1944-7884
• DOI: 10.1097/QAI.0000000000003404

Efforts to control the COVID-19 pandemic have potentially compromised the availability and/or quality of HIV services. We aimed to assess the pandemic's impact on antiretroviral therapy (ART) initiation and HIV viral load (VL) monitoring in 3 West African countries.
We used routinely collected data from 5 clinics contributing to the International epidemiologic Database to Evaluate AIDS collaboration in Burkina Faso, Côte d'Ivoire, and Nigeria. We included ART-naïve adults living with HIV initiating ART from January 1, 2018. We conducted regression discontinuity analysis to estimate changes in the number of ART initiations and VL measures per week, before and during the pandemic period in each country.
In clinics in Burkina Faso and Côte d'Ivoire, ART initiations per week remained constant throughout the studied periods (-0.24 points (p) of ART initiations/week 95% CI: -5.5 to 5.9, -0.9 p, 95% CI: -8.5 to 8.6, respectively), whereas in Nigeria's clinic, they decreased significantly (-6.3 p, 95% CI: -10.8 to -1.7) after the beginning of the pandemic. The volume of VL tests performed decreased significantly in all 3 countries (-17.0 p, 95% CI: -25.3 to -8.6 in Burkina Faso, -118.4 p, 95% CI: -171.1 to -65.8 in Côte d'Ivoire and -169.1 p, 95% CI: -282.6 to -55.6 in Nigeria).
HIV clinics in two out of three countries in West Africa demonstrated resilience as they successfully maintained access to ART for ALWH despite the challenges imposed by the pandemic. However, VL monitoring was severely disrupted and did not return to prepandemic levels approximately 1 year after the beginning of the pandemic. Continued monitoring of the HIV care continuum in the postpandemic period is essential to mitigate potential enduring effects on ALWH's virological and clinical outcomes.