背景:关键人群(KP),包括男男性行为者(MSM),女性性工作者(FSW),和变性妇女(TGW),经历不成比例的艾滋病毒负担,即使在像南非这样的普遍流行病中。鉴于这一不成比例的负担和获得卫生服务的独特障碍,持续提供护理尤其重要。目前尚不清楚COVID-19大流行及其相关限制可能如何影响这种交付。在这项研究中,我们旨在描述南非KP参与HIV预防和治疗服务的模式,并评估不同COVID-19限制水平对服务提供的影响.
方法:我们利用了由美国总统的艾滋病紧急救援计划(PEPFAR)支持的南非KP合作伙伴收集的计划数据。我们根据国家COVID-19限制期将数据分为三个离散的时间段:(I)限制前,(二)高级别限制期,和(iii)高级限制期后。主要结果包括每月总艾滋病毒检测,发现新的艾滋病毒病例,新的暴露前预防(PrEP)的启动,以及抗逆转录病毒疗法(ART)的新注册。我们进行了中断的时间序列分段回归分析,以评估COVID-19限制对HIV预防和治疗服务利用的影响。
结果:在2018年1月至2022年6月之间,总共进行了231,086次HIV检测,27,051例艾滋病毒阳性病例,27,656预暴露预防(PrEP)启动,MSM中的15,949种抗逆转录病毒治疗,南非PEPFAR支持的KP计划中的FSW和TGW。在“限制前”期间,我们记录了90,457项HIV检测,有13,593例确诊的新艾滋病毒诊断;在“高级别限制”期间,总共有26,134例艾滋病毒检测,其中有2,771例新诊断;在高级别限制之后,有114,495例艾滋病毒检测,其中有10,687例新诊断。我们的泊松回归模型估计表明,在COVID-19限制开始时,服务参与度立即显著下降,包括艾滋病毒检测的下降,治疗,和PrEP使用,坚持。随着计划适应新的限制,服务参与度逐渐反弹,特别是在MSM和FSW中。在高级别限制期接近尾声时,日常生活的某些方面恢复正常,但其他方面仍然受到限制,有更多的可变性。一些指标继续改善,而其他人则停滞不前或减少。
结论:服务提供从与大流行相关的限制造成的最初冲击中反弹,在南非,KP基本上维持了艾滋病毒服务。这些结果表明,为KP设计的计划中的HIV服务提供能够灵活且适应不断变化的限制。这项研究的结果可以为未来的流行病和大规模中断提供艾滋病毒服务的计划提供信息。
BACKGROUND: Key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), and transgender women (TGW), experience a disproportionate burden of HIV, even in generalized epidemics like South Africa. Given this disproportionate burden and unique barriers to accessing health services, sustained provision of care is particularly relevant. It is unclear how the COVID-19 pandemic and its associated restrictions may have impacted this delivery. In this study, we aimed to describe patterns of engagement in HIV prevention and treatment services among KP in South Africa and assess the impact of different COVID-19 restriction levels on service delivery.
METHODS: We leveraged programmatic data collected by the US President\'s Emergency Plan for AIDS Relief (PEPFAR)-supported KP partners in South Africa. We divided data into three discrete time periods based on national COVID-19 restriction periods: (i) Pre-restriction period, (ii) High-level restriction period, and (iii) After-high level restriction period. Primary outcomes included monthly total HIV tests, new HIV cases identified, new initiations of pre-exposure prophylaxis (PrEP), and new enrollments in antiretroviral therapy (ART). We conducted interrupted time series segmented regression analyses to estimate the impact of COVID-19 restrictions on HIV prevention and treatment service utilization.
RESULTS: Between January 2018 and June 2022, there were a total of 231,086 HIV tests, 27,051 HIV positive cases, 27,656 pre-exposure prophylaxis (PrEP) initiations, and 15,949 antiretroviral therapy initiations among MSM, FSW and TGW in PEPFAR-supported KP programs in South Africa. We recorded 90,457 total HIV tests during the \'pre-restriction\' period, with 13,593 confirmed new HIV diagnoses; 26,134 total HIV tests with 2,771 new diagnoses during the \'high-level restriction\' period; and 114,495 HIV tests with 10,687 new diagnoses during the after high-level restriction period. Our Poisson regression model estimates indicate an immediate and significant decrease in service engagement at the onset of COVID-19 restrictions, including declines in HIV testing, treatment, and PrEP use, which persisted. As programs adjusted to the new restrictions, there was a gradual rebound in service engagement, particularly among MSM and FSW. Towards the end of the high-level restriction period, with some aspects of daily life returning to normal but others still restricted, there was more variability. Some indicators continued to improve, while others stagnated or decreased.
CONCLUSIONS: Service provision rebounded from the initial shock created by pandemic-related restrictions, and HIV services were largely maintained for KP in South Africa. These results suggest that HIV service delivery among programs designed for KP was able to be flexible and resilient to the evolving restrictions. The results of this study can inform plans for future pandemics and large-scale disruptions to the delivery of HIV services.