Impact of COVID-19 Public Health Measures on Antiretroviral Therapy Use Among Ugandans Living with HIV in Sero-Different Couples

TL;DR

This study found that Ugandans with HIV in serodifferent couples maintained effective ART use and viral suppression even during strict COVID-19 lockdowns.

Contribution

The study demonstrates that ART initiation and viral suppression were not significantly disrupted by early pandemic restrictions in Uganda.

Findings

88.8% of participants in Period 1 achieved viral suppression within six months of ART initiation.

Viral suppression rates remained statistically similar across all three study periods despite lockdowns.

PLHIV in serodifferent couples successfully maintained ART use during the pandemic.

Abstract

Antiretroviral therapy (ART) use and HIV suppression among people living with HIV (PLHIV) are critical for HIV control and prevention. Extreme restrictions on movement early during the COVID-19 pandemic in Uganda may have impeded the ability to initiate and sustain access to and use of ART. From our stepped-wedge cluster-randomized trial of an integrated PrEP and ART intervention for HIV-serodifferent couples at 12 ART clinics in Uganda, we identified participants who enrolled and had a 6-month post-ART initiation viral load measured before the beginning of the first COVID-19 lockdown (Period 1), participants whose enrollment and 6-month viral load measurement straddled pre-COVID and COVID lockdown times (Period 2), and participants whose enrollment and 6-month viral load were quantified entirely during COVID-19 (Period 3). ART and viral load data were abstracted from standard-of-care HIV clinic records. We used adjusted generalized estimating equation models to compare viral suppression between the different periods. We enrolled 1,381 PLHIV, including 896 (64.9%) in Period 1, 260 (18.8%) in Period 2, and 225 (16.3%) in Period 3. Almost all (1371, 99.3%) initiated ART within 90 days of enrollment and 59.2% had baseline CD4 > 350 cells/mm3. Among those enrolled, 88.8% of participants in Period 1 were virally suppressed (< 1000 copies/mL) within six months of ART initiation, 80.5% in Period 2, and 88.2% in Period 3. All pairwise comparisons demonstrated statistically similar levels of viral suppression. Despite COVID-19 lockdown measures, PLHIV in serodifferent partnerships successfully initiated ART and attained and maintained viral suppression.