The COVID-19 pandemic could lead to disruptions to provision of services for people with HIV in sub-Saharan Africa, but the relative consequences for HIV mortality and incidence of disruptions of different activities is not widely appreciated, and neither is the potential absolute magnitude of impact. 9 In a May, 2020, WHO survey in five of 13 countries in sub-Saharan Africa, antiretroviral therapy (ART) stock availability for major first-line drugs was reported to be 3 months or less, with reasons including failure of suppliers to deliver on time (Low-Beer D, WHO, Geneva, Switzerland, personal communication). 7 A rapid survey assessment in Zimbabwe in April, 2020, found 19% of people with HIV attempting to get a refill of an antiretroviral drug had not been able to, or were only able to get a partial refill, 8 while a telephone-based survey in Kenya and Nigeria run by the Finmark Trust in April, 2020, found 14% of people were unable to collect needed medications. A survey of people living with HIV run by the Human Sciences Research Council in South Africa via a social media platform found that 13% of people said they did not have access to their chronic medication during lockdown, 6 with some reports in the area as of May, 2020, showing that only 30–50% of patients were collecting their medication. Negative effects of the COVID-19 epidemic on access to health services have begun to emerge. 4 Concern exists that possible disruptions in HIV programmes due to COVID-19 1, 2, 5 could affect HIV-related mortality and new infections. HIV remains highly prevalent in sub-Saharan Africa with over 25♷ million (uncertainty range 22♲–29♵) people estimated to be living with HIV in the region in 2018. 1, 2, 3 Causes of such disruption could include COVID-19-related morbidity and mortality, clinic closures or reduced service availability, and physical distancing and other measures put in place to combat the virus spread. Interruption to condom supplies and peer education would make populations more susceptible to increases in HIV incidence, although physical distancing measures could lead to reductions in risky sexual behaviour (up to 1♱9 times increase in new HIV infections over a 1-year period if 50% of people are affected).ĭisruption to delivery of health care in sub-Saharan African settings caused by COVID-19 could lead to adverse consequences for the health of people beyond those from COVID-19 itself. Although an interruption in the supply of ART drugs would have the largest impact of any potential disruptions, effects of poorer clinical care due to overstretched health facilities, interruptions of supply of other drugs such as co-trimoxazole, and suspension of HIV testing would all have a substantial effect on population-level mortality (up to a 1♰6 times increase in HIV-related deaths over a 1-year period due to disruptions affecting 50% of the population compared with no disruption).
![1900 stover ct newton nc 1900 stover ct newton nc](https://www.thegreatmorel.com/wp-content/uploads/2018/04/FB_IMG_1525082701217-Large.jpg)
Interruption of ART would increase mother-to-child transmission of HIV by approximately 1♶ times. In sub-Saharan Africa, this increase amounts to a median excess of HIV deaths, across all model estimates, of 296 000 (range 229 023–420 000) if such a high level of disruption occurred.
![1900 stover ct newton nc 1900 stover ct newton nc](https://www.thegreatmorel.com/wp-content/uploads/2018/04/20180419_192654-Large.jpeg)
![1900 stover ct newton nc 1900 stover ct newton nc](https://www.thegreatmorel.com/wp-content/uploads/2018/04/NC_Durham_20180422_IIMG_3818-Large.jpg)
A 6-month interruption of supply of antiretroviral therapy (ART) drugs across 50% of the population of people living with HIV who are on treatment would be expected to lead to a 1♶3 times (median across models range 1♳9–1♸7) increase in HIV-related deaths over a 1-year period compared with no disruption.