Impact of the COVID-19 Pandemic on the Medical Follow-up and Psychosocial Well-Being of People Living With HIV

A Cross-Sectional Survey

Joseph Nelson Siewe Fodjo, MD; Edlaine Faria de Moura Villela, MD, PhD; Stijn Van Hees, PharmD; Thalia Tibério dos Santos; Pieter Vanholder, MA; Patrick Reyntiens; Rafael Van den Bergh, PhD; Robert Colebunders, MD, PhD


J Acquir Immune Defic Syndr. 2020;85(3):257-262. 

In This Article


Study Design

This was a cross-sectional study conducted among PLWH between April 9, 2020, and May 17, 2020. An online questionnaire was designed to assess the impact of the current COVID-19 pandemic on the life of PLWH. Respondents were invited to participate by filling the questionnaire through a web link that was disseminated through the networks of various associations that support PLWH, including the European AIDS Treatment Group, Sensoa (Flemish center of expertise for sexual health), and RNP+Brasil (National Network of PLWH in Brazil). The questionnaire consisted of 4 parts as follows: inquiring on sociodemographic data, HIV-related information, COVID-related data, and questions on personal health as well as screening tests for psychosocial disorders (anxiety and depression). The screening tests used were the Population Health Questionnaire (PHQ-2) for depression[20] and the Generalized Anxiety Disorder (GAD-2) tool for anxiety.[21] The questionnaire was available in English, Dutch, French, Russian, and Portuguese; it was hosted on the secure website of the International Citizen Project COVID-19.[22] Only respondents who were at least 18 years old and who self-confirmed being PLWH were included. There were no exclusion criteria. An e-consent was required before submitting the responses. Participants were not promised nor given any form of compensation for their participation. A duplicate of the survey template can be found in the supplementary material of this article (see Appendix 6, Supplemental Digital Content, The study protocol was approved by the Ethics Committee of the University of Antwerp (Belgium), Ref: 20/14/179.


Generalized anxiety disorders were defined as having a GAD-2 score of at least 3. Similarly, all respondents who scored 3 or more on the PHQ-2 screening tool were considered as having major depressive disorders. Based on self-reported flu-like symptoms, the World Health Organization (WHO) clinical case definition for COVID-19 was applied on our data; any respondent who had experienced fever associated with at least one respiratory symptom (cough, shortness of breath, sore throat, and coryza) was considered as a suspected case of COVID-19.[23]

Statistical Analyses

Continuous variables were reported as mean with SD (mean ± SD) and compared across groups using nonparametric tests. Categorical variables were summarized into numbers with percentages; proportions were compared using the Yates-corrected χ2 test. A multiple logistic regression analysis was performed to investigate factors associated with the development of flu-like illness since January 2020, when the COVID-19 started spreading to other countries and continents beyond the initial focus in China. Covariates for the final model were purposefully selected and included: sociodemographic variables (age, sex, and country classification as lower-income and middle-income countries [LMIC] vs high-income countries [HIC] based on the World Bank data[24]), COVID-19 prevention (observance of physical distancing and mask use), and other health-related information (CD4 count, flu vaccination received during the past 12 months, treatment with tenofovir-containing ART regimens, and adaptation of HIV care during the lockdown). The rationale for choosing these covariates is summarized in the supplementary material (see Appendix 5, Supplemental Digital Content, All statistical tests were two-sided; P < 0.05 was considered statistically significant, and 95% CIs were computed. Statistical analyses were performed in R version 3.6.2.