Assessing the impact of the COVID-19 restrictions on HIV testing services in Malawi: an interrupted time series analysis
Rattachement africain : Malawi, ca, us, Mali. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background: Restrictions on public gatherings and movement to mitigate the spread of COVID-19 may have disrupted access and availability of HIV services in Malawi. We quantified the impact of these restrictions on HIV testing services in Malawi.Methods: We conducted an interrupted time series analysis of routine aggregated programme data from 808 public and private, adult and paediatric health facilities across rural and urban communities in Malawi between January 2018 and March 2020 (pre-restrictions) and April to December 2020 (post restrictions), with April 2020 as the month restrictions took effect. Positivity rates were expressed as the proportion of new diagnoses per 100 persons tested. Data were summarised using counts and median monthly tests stratified by sex, age, type of health facility and service delivery points at health facilities. The immediate effect of restriction and post-lockdown outcomes trends were quantified using negative binomial segmented regression models adjusted for seasonality and autocorrelation.Results: The median monthly number of HIV tests and diagnosed people living with HIV (PLHIV) declined from 261 979 (interquartile range [IQR] 235 654–283 293) and 7 929 (IQR 6 590–9 316) before the restrictions, to 167 307 (IQR 161 122–185 094) and 4 658 (IQR 4 535–5 393) respectively, post restriction. Immediately after restriction, HIV tests declined by 31.9% (incidence rate ratio [IRR] 0.681; 95% CI 0.619–0.750), the number of PLHIV diagnosed declined by 22.8% (IRR 0.772; 95% CI 0.695–0.857), while positivity increased by 13.4% (IRR 1.134; 95% CI 1.031–1.247). As restrictions eased, total HIV testing outputs and the number of new diagnoses increased by an average of 2.3% each month (slope change: 1.023; 95% CI 1.010–1.037) and 2.5% (slope change:1.025; 95% CI 1.012–1.038) respectively. Positivity remained similar (slope change: 1.001; 95% CI 0.987–1.015). Unlike general trends noted, while HIV testing services among children aged <12 months declined 38.8% (IRR 0.351; 95% CI 0.351–1.006) with restrictions, recovery has been minimal (slope change: 1.008; 95% CI 0.946–1.073).Conclusion: COVID-19 restrictions were associated with significant but short-term declines in HIV testing services in Malawi, with differential recovery in these services among population subgroups, especially infants. While efforts to restore HIV testing services are commendable, more nuanced strategies that promote equitable recovery of HIV testing services can ensure no subpopulations are left behind.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Assessing the impact of the COVID-19 restrictions on HIV testing services in Malawi: an interrupted time series analysis
- Date Crossref
- 03/04/2023
- Éditeur
- National Inquiry Services Center (NISC)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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National AIDS Commission Malawi (code pays fourni par la source)Organisme public
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University of British Columbia pays non établi dans la noticeUniversité ou école supérieure
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Family Health International 360 pays non établi dans la noticeOrganisation à but non lucratif
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Mali-Folkecenter Mali (code pays fourni par la source)Institution
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Lilongwe FHI360 Lilongwe, Malawi (pays nommé en fin d’affiliation)Organisation à but non lucratif
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School of Population and Public Health pays non établi dans la noticeUniversité ou école supérieure
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Department of Global Health Abuja, Nigéria (pays nommé en fin d’affiliation)Institution
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Public Health Information Abuja, Nigéria (pays nommé en fin d’affiliation)Institution
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TB DIAH/John Snow Inc. Abuja, Nigéria (pays nommé en fin d’affiliation)Entreprise
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FHI360 Monrovia, Libéria (pays nommé en fin d’affiliation)Institution
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Washington DC pays non établi dans la noticeInstitution
National AIDS Commission (Malawi), University of British Columbia et Family Health International 360, avec 8 autres affiliations. Pays d’affiliation : Malawi, Mali, Nigéria, Libéria.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.