Abstract
Background: The COVID-19 pandemic might have disrupted the provision and utilisation of essential HIV services such as antiretroviral therapy (ART) initiation, retention and adherence for people living with HIV (PLHIV). There is a need to understand how the COVID-19 pandemic has reduced the utilisation of ART services for PLHIV in KwaZulu-Natal Province of South Africa, which was heavily affected by both HIV and COVID-19.
Aim: To assess ART uptake and associated factors during the COVID-19 lockdown period among PLHIV in a selected district in the KwaZulu-Natal Province of South Africa.
Methods: A retrospective study design was conducted to analyse national routine programme data from the Department of Health (DoH), iLembe District of KwaZulu-Natal Province. De- identified and aggregated data on HIV-related factors (HIV testing, ART adherence) and socio-demographic factors (age, facility) for the period January 2019 – December 2020 were analysed. All the statistical analysis was conducted using STATA software version 17 (College Station, TX, USA). Descriptive statistics were used to report the frequencies and percentages for HIV testing and ART adherence by COVID-19 period, gender and facility. Chi-square tests were utilised to determine the factors associated with HIV testing and ART adherence. Statistical significance was set at a p-value of ≤ 0.05 and a 95% confidence interval (CI).
Results: The majority of the females (n=12,218 and n=14,274) did HIV testing before and during COVID-19 than males (n=6,182 and n=9,189). Gender was associated with the number of HIV tests done in KwaDukuza clinic (p=0.013) and Groutville clinic (p<0.001) before the COVID-19 pandemic. During the COVID-19 pandemic, gender was also associated with the number of HIV tests performed at KwaDukuza clinic (p=<0.001), Shakaskraal clinic (p=<0.001), and Groutville clinic (p<0.001). The number of PLHIV retained on ART was n=261,178 before the COVID-19 pandemic and n=263,308 during the COVID-19 pandemic. Regarding the facilities, in Groutville clinic, 77,725 PLHIV were retained on ART before COVID-19 and 80,306 PLHIV during the COVID-19 period. Similarly, Shakaskraal Clinic and Groutville clinic recorded a slight increase in the number of PLHIV retained on ART: 54,582 to 57,645 and 59,681 to 61,316, respectively.
Conclusion: Gender was associated with HIV testing uptake at the facility level before and during the COVID-19 pandemic period.