The impact of COVID-19 epidemic on HIV care in Croatia

Background: HIV care in Croatia is centralised and all PLWHIV are treated at the University Hospital for Infectious Diseases (UHID) in Zagreb;the hospital pharmacy also dispenses ART In response to the initial phase of the COVID-19 pandemic a lockdown has been imposed between 16 March and 27 April 2020 UHID became the central hospital for treatment of COVID-19 in the Zagreb area We aim to quantify the impact of COVID-19 epidemic on HIV care at UHID Materials and methods: We reviewed data from all interactions of PLWHIV with the HIV treatment centre from 3 February till 28 June 2020 The following was analysed: phone interactions, office visits, number of viral load (VL) tests performed and interactions that resulted in dispensing ART Data on HIV care was extracted from the local database and periods March-June 2018, 2019 and 2020 were compared Results: The COVID-19 epidemic in Croatia started on 25 February The major increase in confirmed COVID-19 cases happened from 16 to 22 March when 205 cases were confirmed and the peak of outbreak was recorded from 30 May to 5 April when the number of cases was 469 HIV care office visits declined for >50% in March compared to February (average 46 vs 22 5 per week, respectively) An average of 8 5 shipments of ART per week were made in February and 31 shipments per week in March The maximum number of ART shipments (N = 45) and phone consultations (N = 415) were made in a week of epidemic acceleration (16 to 22 March) There were fewer viral load measurements in March-June 2020 compared to 2019 and 2018 and fewer newly HIV-diagnosed persons entered care in 2020 (Figure 1);the median CD4 count/mm3 was 410 5 (2018), 339 5 (2019) and 120 (2020) Conclusions: During the first phase of COVID-19 outbreak a transition from face-to-face communication to mainly telephone consultations was observed Fewer VL measurements were done The observed drop in newly diagnosed persons entering care is probably due to the interruption of the work of community-based and other voluntary counselling and testing centres in Croatia