Effects of the COVID-19 Pandemic on HIV Services: Findings from 11 Sub-Saharan African Countries.

BACKGROUND Concerns about the effects of COVID-19 pandemic on health services span the globe. We examined its effects on HIV services in sub-Saharan Africa. METHODS Data collected quarterly [Q1: October-December 2019; Q2: January-March 2020; Q3: April-June 2020; Q4: July-September 2020] from 1,059 health facilities in 11 countries were analyzed and categorized by stringency of pandemic measures. We conducted a difference-in-differences assessment of HIV service changes from Q1-Q2 to Q3-Q4 by stringency category (high vs. low). RESULTS There was a 3.3% decrease in the number HIV tested from Q2-Q3 (572,845 to 553,780). The number testing HIV-positive declined by 4.9% from Q2-Q3. In Q4, the number tested increased by 10.6% (612,646) from Q3, with increase by 8.8% with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2-Q3 but increased in Q4 by 9.8%. Across all quarters, the number currently on ART increased [419,028 (Q1) to 476,010 (Q4)]. The number receiving viral load (VL) testing in the past 12 months also increased [255,290 (Q1) to 312,869 (Q4)]. No decrease was noted in VL suppression (VLS) [87.5% (Q1) to 90.1% (Q4)]. HIV testing (p<0.0001) and new ART initiations (p=0.001) were inversely associated with stringency measures. CONCLUSIONS While initial declines were observed, rebound was brisk as the pandemic progressed, with increases noted in the number HIV tested, newly-initiated or currently on ART, VL testing, and VLS throughout the period, demonstrating substantial HIV program resilience in the face of the COVID-19 crisis.