Evaluating the impact of the COVID-19 pandemic on viral load and CD4 monitoring for people living with HIV on ART in rural Lesotho

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INTRODUCTION: With the rapid spread of COVID-19, many governments put various measures in place to contain the spread of the pandemic. These measures, such as travel restrictions, curfews, and public gatherings, may affect health service delivery, including monitoring of viral load and CD4 for People Living with HIV (PLHIV) on antiretroviral therapy (ART). Lesotho is a lower-middle-income country with one of the world's highest prevalence of HIV (22%). This study aims to examine the effect of COVID-19 on viral load and CD4 monitoring of PLHIV on ART in Lesotho. METHODS: We employed routine data from seven Ministry of Health health centers supported by Partners In Health from March 2017 to February 2023. We extracted de-identified data for all patients with HIV on ART who were followed by the health centers, including demographic variables of interest, viral load, and CD4 count. We analyzed the data using the chi-squared tests of independence to compare before and after COVID-19, and we used a logistic regression model predicting a result of "suppressed" and advanced disease as binary outcome variables. RESULTS: We observed significantly higher rates of viral load suppression and CD4 counts > 200 with p-values < 0.001 during the COVID-19 pandemic, March 2020, 2021, 2022, and 2023, versus before the pandemic in March 2017, 2018, 2019, and February 2020. Fewer patients seen during the pandemic were classified as having "advanced HIV" based on CD4 count (< 200 cells/ml) test results during COVID (7.0%) than before (8.0%), though it was no significant and likewise, fewer PLHIV seen during the COVID-19 pandemic were "unsuppressed" based on viral load (> 1000 copies/ml) (11.1%) vs. before the pandemic (15.8%) which was significant with p-value < 0.001. CONCLUSIONS: Maintaining high viral load suppression in remote and rural communities during the pandemic is possible. A robust primary health system and strong pandemic preparation and response plans are crucial for effective HIV program response. Measures and communication introduced into the viral load and CD4 monitoring during the pandemic outbreak are paramount for sustaining the viral load suppression and ultimately reducing new HIV transmission.

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