# Impact of COVID-19 on the HIV Treatment Outcomes Among Men Who Have Sex with Men in South Africa After the Implementation of a Differentiated Service Delivery Model: An Interrupted Time Series Analysis

## TL;DR

This study shows that a new HIV service model helped improve treatment outcomes for men who have sex with men in South Africa during the COVID-19 pandemic.

## Contribution

The study quantifies the positive impact of a differentiated service delivery model on HIV treatment outcomes during the pandemic for a vulnerable group.

## Key findings

- The DSD model led to significant increases in HIV testing and linkage to care during the pandemic.
- ART initiation and viral load testing also improved after the implementation of the DSD model.
- Overall, HIV treatment outcomes showed an upward trend during the lockdown period.

## Abstract

The impacts of COVID-19 among men who have sex with men (MSM), who face limited access to HIV services due to stigma, discrimination, and violence, need to be assessed and quantified in terms of HIV treatment outcomes for future pandemic preparedness. This study aimed to evaluate the effects of the COVID-19 lockdown on the HIV treatment cascade among MSM in selected provinces of South Africa using routine programme data after the implementation of differentiated service delivery (DSD) models. An interrupted time series analysis was employed to observe the trends and patterns of HIV treatment outcomes among MSM in Gauteng, Mpumalanga, and KwaZulu-Natal from 1 January 2018 to 31 December 2022. Interrupted time series analysis was applied to quantify changes in the accessibility and utilisation of HIV treatment services using the R software version 4.4.1. The segmented regression models showed a decrease followed by an upward trend in all HIV treatment outcomes. After the implementation of the DSD model, significant increases in positive HIV tests (estimate = 0.001572; p < 0.001), linkage to HIV care (estimate = 0.001486; p < 0.001), ART initiations (estimate = 0.001003; p = 0.004), ART collection (estimate = 0.001748; p < 0.001), and taking viral load tests (estimate = 0.001109; p = 0.001) were observed. There was an overall increase in all HIV treatment outcomes during the COVID-19 lockdown in light of the DSD model.