Study: COVID-19 Pandemic Leads to Decrease in HIV-Related Services in India

The numbers dropped sharply in March 2020 from before the pandemic among men who have sex with men and individuals who inject drugs.

The COVID-19 pandemic led to a significant decrease in HIV-related service use among specific populations in India, which could lead to increased transmission and patients with advanced disease among groups who are disproportionately affected by HIV, according to the results of a study published in the Journal of the International AIDS Society.

In the study, investigators gathered data on 13,854 individuals who visited an integrated care centers between January 2020 and June 2021. In January/February 2020, the average number of monthly clients was 3761.

Investigators found that the number of clients who received services declined sharply in March 2020 compared with the number pre-pandemic. They found that these numbers dropped to 25% of pre-pandemic levels in April/May 2020 (wave 1), followed by a slow rebound until a decline of 57% in April/May 2021 (wave 2).

Investigators noticed a similar trajectory with HIV testing. Over time, they noticed that HIV testing changed positively, then declined in the first wave, reaching the lowest point around July 2020 at approximately 50% of the pre-pandemic levels, then positively increasing and eventually settling higher than before the pandemic.

Investigators found that there was a decline in positivity for men who have sex with men (MSM) during the second wave, but they found it was unchanged for individuals who inject drugs.

Among the 1650 individuals who have HIV and were surveyed, 52% of individuals who inject drugs and 45% of MSM reported that the pandemic affected their ability to see their HIV provider.

Additionally, investigators found that MSM had barriers in accessing sexually transmitted infection testing and partner HIV testing.

In 2013, investigators established intra-cluster correlations (ICCs) which provided HIV preventive and treatment services to individuals who inject drugs and MSM across 15 Indian sites. They estimated patterns for utilization for an 18-month period which covered 2 months before the pandemic, January and February 2020, as well as over the course of the first and second COVID-19 waves in India, from March 2020 until June 2021.

The investigators assessed unique individuals accessing any ICC service, ICC services provided, unique individuals tested for HIV and HIV diagnoses and test positivity. They also provided a survey to the established cohort, MSM and individuals who inject drugs who have HIV, on the pandemic’s impact on HIV care and treatment.

Investigators noted several limitations to the study, including that they had service data from a single center in each city, so it is possible other individuals visited other facilities.

Additionally, the survey was only administered to individuals with HIV who enrolled in the cohort study who could all differ in HIV care and treatment engagement. They also said that the most vulnerable individuals might not have been reached in the study, so the barriers could be more substantial than their results.

Finally, the survey investigators administered in June/August 2020 did not cover the impact of the second COVID-19 wave.

Reference

McFall, AM, Menezes, NP, Srikrishnan, AK, Solomon, SS, et al. Impact of the COVID-19 pandemic on HIV prevention and care services among key populations across 15 cities in India: a longitudinal assessment of clinic-based data. J Int AIDS Soc. 2022;25(7):e25960. doi: 10.1002/jia2.25960