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How paediatric HIV services weathered the COVID-19 storm in Tshwane District, South Africa
Michael Christie1,2,3, Ahmad Haeri Mazanderani4,5, Gayle Sherman4,5
1Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Insights
The COVID-19 pandemic initially disrupted paediatric HIV services in South Africa, leading to reduced care engagement. While services recovered to near pre-pandemic levels, some children may not have returned, highlighting ongoing challenges in paediatric HIV management.
Area of Science:
- Public Health
- Infectious Diseases
- Paediatric Medicine
Background:
- The COVID-19 pandemic significantly disrupted essential health services globally.
- South Africa had recently updated its national HIV guidelines shortly before the pandemic's onset.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic on paediatric HIV services in Tshwane District, South Africa.
- To analyze changes in Early Infant Diagnosis (EID), viral load (VL), and CD4 monitoring for children living with HIV (CLHIV).
Main Methods:
- A retrospective data review was conducted for Tshwane District from April 2019 to March 2022.
- Data from the National Institute for Communicable Diseases and District Health Information System were analyzed.
- Paediatric HIV service indicators were compared between pre-pandemic and pandemic periods.
Main Results:
- HIV testing at 10 weeks, 6 months, and 18 months improved, but birth testing decreased.
- Antiretroviral treatment initiation declined initially but improved in the second pandemic year.
- Initial HIV viral load and CD4 testing decreased, with viral load testing recovering while CD4 testing continued to decline.
Conclusions:
- COVID-19 initially led to disengagement from paediatric HIV care, with services gradually recovering.
- Despite recovery, compensatory increases in services did not occur, suggesting potential gaps in care for some children.
- Ongoing monitoring is crucial to ensure all children living with HIV receive continuous care and achieve viral suppression.
Background:
The coronavirus disease 2019 (COVID-19) pandemic disrupted paediatric HIV services across South Africa. Shortly before COVID-19, updated national HIV guidelines were released.
Objectives:
This study describes COVID-19's impact on paediatric HIV services in Tshwane District, South Africa.
Method:
A retrospective review of National Institute for Communicable Diseases and District Health Information System data for Tshwane District from April 2019 to March 2022. Data included: Early Infant Diagnosis (EID), HIV viral load (VL) and CD4 monitoring and HIV management among children (< 15 years) living with HIV (CLHIV). Pre-pandemic (2019/2020) and pandemic periods (2020/2021, 2021/2022) were compared.
Results:
Year-on-year, HIV testing improved at 10 weeks, 6 months, and 18 months, whereas birth testing decreased. HIV EID case rates were 485 (2019/2020), 410 (2020/2021) and 454 (2021/2022). HIV EID test positivity was 0.77% - 1.2%. Antiretroviral treatment initiation declined from 2019/2020 to 2020/2021, but improved in 2021/2022.Initial HIV VL and CD4 testing declined, with HIV VL testing increasing in 2021/2022, and CD4 testing further declining. HIV VL suppression rate among CLHIV ranged from 69% to 73%.
Conclusion:
Initially, COVID-19 resulted in reduced paediatric HIV services as children disengaged from care. Indicators eventually recovered to proximate pre-pandemic levels; however, compensatory increases did not occur. Thus, some children may not have returned to care.
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