Comment:Maintaining HIV care during the COVID-19 pandemic

Jiang, H., Zhou, Y., & Tang, W. (2020). Maintaining HIV care during the COVID-19 pandemic. The Lancet HIV, 7(5), e308-e309. 

Coronavirus disease 2019 (COVID-19) has spread rapidly around the world since the first reports from Wuhan in China in December, 2019, and the outbreak was characterised as a pandemic by WHO on March 12, 2020.1 Approximately 37·9 million people living with HIV2 are at risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. Although some international institutions, in collaboration with governments and community partners, are working to sustain HIV service provision for people living with HIV, the COVID-19 pandemic presents several barriers and challenges to the HIV care continuum.3 First, implementation of quarantine, social distancing, and community containment measures have reduced access to routine HIV testing, which challenges completion of UNAIDS' first 90-90-90 target globally, that 90% of all people living with HIV will know their HIV status. HIV testing is the vital first step towards initiation into the HIV care continuum.3 Even with availability of HIV self-testing kits in some areas,4 testing remains a big challenge in settings with scarce access to these kits. Therefore, increased efforts are needed to augment access and to facilitate testing. • 

View related content for this article Second, timely linkage to HIV care could be hindered during the COVID-19 pandemic. People living with HIV who should have initiated antiretroviral therapy (ART) in hospital might be deterred or delayed because hospitals are busy treating patients with COVID-19. Furthermore, because many public health authorities globally are focused on COVID-19 control, allocation of resources for HIV care could be diminished, and circumstances surrounding the HIV care continuum could worsen. Third, the COVID-19 pandemic might also hinder ART continuation. 

Hospital visits could be restricted because of the implementation of city lockdowns or traffic controls. UNAIDS and the BaiHuaLin alliance of people living with HIV, with support of the Chinese National Center for AIDS/STD Control and Prevention, did a survey among people living with HIV in China in February, 2020.5, 6 Among this population, 32·6% were at risk of ART discontinuation and about 48·6% did not know where to get antiviral drugs in the near future.5, 6 People living with HIV who are faced with ART discontinuation not only could undergo physical health deterioration but also might suffer great psychological pressure.