Romain Silhol1, Lily Geidelberg1, Kate M Mitchell1, Sharmistha Mishra2, Dobromir Dimitrov3, Anna Bowring4, Luc Béhanzin5, Fernand Guédou6, Souleymane Diabaté7, Sheree Schwartz4, Serge C Billong8, Iliassou Mfochive Njindam4, Daniel Levitt9, Christinah Mukandavire10, Mathieu Maheu-Giroux11, Minttu M Rönn12, Shona Dalal13, Peter Vickerman14, Stefan Baral4, Michel Alary7, Marie-Claude Boily1. 1. MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, United Kingdom. 2. Department of Medicine, Division of Infectious Disease, University of Toronto, Toronto, Ontario, Canada. 3. Fred Hutchinson Cancer Research Center, Seattle, WA. 4. Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 5. National School of Public Health and Epidemiological Surveillance workers, Parakou University, Bénin. 6. Free STI clinic, Cotonou Communal Health Center, Cotonou, Bénin. 7. Population Health and Optimal Health Practices, Québec University Hospital Research Center, Laval University, Québec, Quebec, Canada. 8. Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon. 9. HIV/AIDS Heath Equity and Rights, CARE USA, New York, NY. 10. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. 11. Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Quebec, Canada. 12. Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA. 13. Department of HIV/AIDS, World Health Organization, Geneva, Switzerland; and. 14. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Abstract
BACKGROUND: The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men, and overall. SETTING: Yaoundé (Cameroon) and Cotonou (Benin). METHODS: We used mathematical models of HIV calibrated to city population-specific and risk population-specific demographic/behavioral/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared with a scenario without COVID-19. RESULTS: A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31%, and 23% among men who have sex with men, FSW, clients, and overall in Yaoundé, respectively, and 69%, 49%, and 23% among FSW, clients, and overall, respectively, in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. CONCLUSIONS: Reductions in condom use after COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritized to minimize short-term excess HIV-related deaths.
BACKGROUND: The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men, and overall. SETTING: Yaoundé (Cameroon) and Cotonou (Benin). METHODS: We used mathematical models of HIV calibrated to city population-specific and risk population-specific demographic/behavioral/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared with a scenario without COVID-19. RESULTS: A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31%, and 23% among men who have sex with men, FSW, clients, and overall in Yaoundé, respectively, and 69%, 49%, and 23% among FSW, clients, and overall, respectively, in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. CONCLUSIONS: Reductions in condom use after COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritized to minimize short-term excess HIV-related deaths.
Authors: Leslie A Enane; Edith Apondi; Claire Liepmann; Judith J Toromo; Mark Omollo; Salim Bakari; Michael Scanlon; Kara Wools-Kaloustian; Rachel C Vreeman Journal: BMJ Open Date: 2022-03-30 Impact factor: 3.006
Authors: Gulzar H Shah; Gina D Etheredge; Jessica S Schwind; Lievain Maluantesa; Kristie C Waterfield; Astrid Mulenga; Osaremhen Ikhile; Elodie Engetele; Elizabeth Ayangunna Journal: Healthcare (Basel) Date: 2022-08-12