COVID-19 turned our world upside down, forcing us to rethink how we deliver health care, particularly around the provision of ongoing HIV-testing and follow-up services. For people already infected with HIV, the pandemic presented a double whammy – a bigger susceptibility to Covid-infections and serious illness because of a compromised immune system, and not having access to regular testing to determine issues such as viral load and possible resistance to existing treatment.

A study1 conducted at 2741 public facilities in South Africa showed a sharp decline in ART initiations from March 2020 to March 2021; this indicates that many newly infected people couldn’t access early treatment due to limited testing services and overwhelmed laboratories.

Patricia Mahome is an HIV Clinical and Specialist Case Manager at LifeSense Disease Management. During the pandemic, they had 22 000 people with HIV enrolled in their management plan.

Reflecting on her work counselling HIV patients during and after the COVID-19 lockdown, Mahome describes it as a period marked by fear and anxiety. However, she also notes that this challenging time led many to appreciate the gift of life and prioritize their health.

“We observed increased adherence to treatment among our patients. They understood that HIV heightened their susceptibility to severe COVID-19 illness and death. This led to a significant shift in mindset. People realized that strict adherence to treatment and minimizing exposure to high-risk environments were crucial for their survival,” Mahome explains.

The stigma challenge

While strategies like 12-month prescriptions and doorstep medication delivery ensured uninterrupted access to treatment, they presented new challenges.

In relationships where one partner was undetectable and untransmissible but had not disclosed their HIV status, questions arose about the purpose of their medication.

“Individuals who feared discrimination were suddenly forced to disclose their status to their partners, potentially leading to conflict and, in some cases, divorce. This underscores the persistence of stigma and the need for ongoing education and awareness. It’s crucial to recognize HIV as just another chronic illness and to understand that open communication can help prevent new infections,” Mahome explains.

While not officially confirmed, there are indications that limited access to testing services may have contributed to delayed diagnoses, particularly among vulnerable groups like women and adolescent girls. This delay in treatment initiation could potentially lead to new infections.

But, according to Mahome a significant increase in individuals seeking HIV testing post-COVID was noticed.

“The pandemic-induced anxiety and fear, heightened self-awareness and motivated people to address other health concerns, including HIV. In a sense, COVID acted as a catalyst, encouraging people to prioritize their health and undergo testing.

Closing the gaps with innovation

Although the pandemic confirmed several gaps in the delivery of HIV services, it encouraged the rapid development of innovations to close those gaps.

The transition to telehealth services expanded access to care for people living with HIV, enabling them to interact with healthcare professionals and counsellors through online consultations. Additionally, to address gaps in testing services, interactive apps have been and are being developed to facilitate self-testing and immediate access to healthcare providers for result interpretation and treatment initiation.

“We’ve found that telephonic consultations often make people more comfortable to share personal information with someone. However, building rapport in a virtual setting can be challenging, as patients may provide brief, closed-ended answers. To encourage open communication, it’s essential to ask probing questions that prompt patients to share their feelings. Despite this challenge, I believe telephonic HIV management remains an effective approach,” Mahome emphasized.

Although challenges remain in terms of monitoring treatment efficacy, advancements in technology, particularly interactive patient apps, offer promising solutions.  These apps can explain test results directly to patients, informing them whether their treatment is effective. Patients can also track their progress and monitor their viral load to see if they are responding to treatment.

Lessons Covid taught us

Yes, the Covid-pandemic exposed vulnerabilities in HIV treatment and management, but it also unexpectedly forced positive change. It demonstrated the critical need for adaptable healthcare systems that can adjust to unforeseen circumstances. Expanding access to telehealth services and medication delivery options proved crucial in ensuring continuity of care for people living with HIV. It heightened awareness of personal health, leading to an increase in post-pandemic HIV testing, underlining the importance of educational campaigns that encourage regular testing and prioritize overall wellbeing.

Covid also revealed the persistence of stigma. Moving forward, ongoing education and awareness efforts are vital to normalize HIV and promote open communication within relationships.

“The COVID-19 pandemic forced us to adapt and innovate, transforming the landscape of HIV care, but most importantly it opened our eyes to how we should appreciate life as human beings,” Mahome concluded.

Reference:

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07714-y