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STUDY: How the COVID-19 Lockdown Severed Access to HIV Medication 

When a total lockdown was effected in Uganda in March 2020, little did Gloria Nawanyaga, who is living with HIV/AIDS, know that access to HIV medication would be severed.

As a person living with HIV, access her daily dose of Anti-Retroviral drugs (ARVs) and periodic refills is crucial.

Under the lockdown, however, public transport came to a halt, travelling by boda bodas was banned and these Covid-19 preventive measures greatly hindered many people living with HIV from accessing medicines according to Nawanyaga.

She (Nawanyaga) told ChimpReports that she witnessed an unfortunate incident where a young person living with HIV died because they could not travel to get their refills and a scheduled treatment for their other health scare – leukaemia with which they were grappling.

“His appointment was during the lockdown and because he couldn’t access transport, we ended up losing him. Even post the COVID-19 total lockdown, we still have the same challenge of access to medication because the transport fares are too expensive as they ware doubled since the reopening of public transport services,” she added.

The deceased was staying in Arua district and used to get his check ups and leaukaemia management medication from the Uganda Cancer Institute in Kampala.

The COVID-19 pandemic has had far reaching impacts on people living with HIV.

A study conducted in Uganda titled: ‘HIV care experiences during the COVID‑19 Pandemic’ published in PubMed Central, an archive of medical journals, reveals that many clients indicated that COVID-19 negatively impacted their travel to HIV clinics.

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Lack of transportation, fear of violating curfew and insufficient money for transportation were the commonly reported barriers on clients’ travel to HIV clinics.

“Most participants (76%) agreed that COVID-19 impacted their ability to come to clinics and slightly more than half (54%) agreed that coming to the clinic increased their chances of getting COVID-19,” the report partially reads.

On the other hand, clients who had friends or relatives with private vehicles (that were allowed to travel during the lockdown) were reluctant to use this method due to the risk of unintended disclosure of their HIV status due to the multiple visits to the HIV clinic.

Dr Timothy Muwonge, a member of the Ministry of Health’s National Post Exposure Prophylaxis (PEP) Technical working group, says that when someone who has been on medication withdraws from the treatment, their viral load surges and the possibility of them acquiring other diseases such as Tuberculosis and meningitis increases.

According to data from UNAIDS, an estimated 1.4 million people were living with HIV in Uganda and about 23,000 died of AIDS-related illnesses in 2018. This indicates that the epidemic is still firmly established in the general population.

COVID-19’s Far Reaching Impacts

A study titled: ‘Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda’ published in the American Journal of Tropical Medicine and Hygiene indicates that identification of new HIV cases declined by 75% in the first two weeks of April.

The researchers predict that the burden accruing from undiagnosed new HIV cases will lead to a decline of new ARV treatment initiation.

Uganda’s situation is similar to what is happening across sub-Saharan Africa according to a study titled: ‘Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19’ published in the Lancet journal in September 2020.

The study notes that a six-month interruption of supply of antiretroviral therapy (ART) drugs due to COVID-19 could lead to more than 500,000 deaths from AIDS-related illnesses, including tuberculosis.

“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 co-trimoxazole, and suspension of HIV testing would all have a substantial effect on population-level mortality,” the report partly reads.

Recent data from PEPFAR also shows that COVID-19 has severed testing and treatment for HIV, including for pregnant women and Anti-retroviral treatment for HIV-positive pregnant women is down to 4.46%.

Additionally, PEPFAR records a worrying 25% decline of HIV treatment initiation for many age groups and a 25% decline in HIV case identification based on reduced testing across all age groups. These declines are consistent with the October 2020 Situation Report of the Global Fund, which indicates that three quarters of Global Fund supported HIV programs have experienced “moderate” to “very high” service disruption in the wake of COVID-19.

Moreover, the 90-90-90 goals set by UNAIDS to tackle HIV/AIDS have been jeopardized by COVID-19. The goals aim to have 90% of all people living with HIV knowing their status, 90% of those diagnosed receiving sustained antiretroviral therapy, and 90% of those receiving ART achieving viral load suppression by end of 2020.

Plausible solutions

A May 2020 study published in ResearchGate on how COVID-19 is impacting engagement with HIV testing services in rural South Western Uganda suggests scale up of HIV self-test distribution as a feasible, sustainable approach to increase access to HIV testing in the context of COVID-19 in Sub-Saharan Africa.

Additionally, the researchers recommend that addressing stigma and discrimination towards people recovering from COVID-19 and towards healthcare workers caring for COVID-19 patients, within these communities should be a priority component of COVID-19 recovery efforts.

 

This article was produced with support from the THRiVE Consortium & Africa Centre for Systematic Reviews & Knowledge Translation.

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