The risks and benefits of providing HIV services during the COVID-19 pandemic

• DOI: 10.1371/journal.pone.0260820
• Publication Date: 2021-12-23T18:48:41Z
• Authors: John Stover; Sherrie L. Kelly; Edinah Mudimu; Dylan Green; Tyler Smith; Isaac Taramusi; Loveleen Bansi-Ma...; Rowan Martin-Hughes; Andrew N. Phillips; Anna Bershteyn
• Keywords: Epidemiology; Science; Population; HIV Infections; Infectious disease (medical specialty); Nursing; FOS: Health sciences; HIV Transmission; Risk Assessment; Health Services Accessibility; 03 medical and health sciences; Engineering; 0302 clinical medicine; Virology; Health Sciences; Pathology; Humans; Viral load; Disease; Global Epidemiology of HIV and Drug Use; Pandemics; Health Services Administration; Public health; Prevention and Treatment of HIV/AIDS Infection; Pandemic; SARS-CoV-2; Impact of COVID-19 Infection on Pregnancy Outcomes; Q; R; COVID-19; Obstetrics and Gynecology; HIV; Human immunodeficiency virus (HIV); Health Services; Models, Theoretical; Transmission (telecommunications); 3. Good health; Coronavirus disease 2019 (COVID-19); Infectious Diseases; Environmental health; Electrical engineering; HIV-1; Medicine; Research Article

Introduction The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services.

Methods We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics.

Results Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19–146 discounted deaths per 10,000 clients.

Discussion While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.