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

Disclosures

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

In This Article

Discussion

Our study provides more insights into the impact of the COVID-19 pandemic on the lives of PLWH around the world. The outbreak has undeniably had its toll on HIV care and has stimulated different adaptations of the health care systems to ensure that PLWH still receive proper follow-up and treatment. Only 18 (5.7%) PLWH had been tested for COVID-19, although the application of WHO diagnostic criteria revealed that the actual number of suspected COVID-19 cases requiring testing in our study population was 3 times higher. This indeed demonstrates that actions against COVID-19 still fall short in many countries, even when it concerns special populations like PLWH.

The GAD-2 and PHQ-2 screening tools revealed that almost one-quarter of PLWH had at least one psychosocial disorder. Considering the entire study population, generalized anxiety disorders were less frequently observed in our survey when compared with previous findings among PLWH before the onset of COVID-19;[15,16] however, the differences in methodologies make it difficult to compare studies. The prevalence of major depressive disorders was much higher in our survey than that observed among PLWH in Kenya using similar methods in a COVID-free setting.[17] A meta-analysis has highlighted that the burden of depression among PLWH was highest in South America;[25] our data showed a similar tendency because the highest prevalence of depression was observed in the Latin American continent (26.7%), although this was not significantly different from the prevalence of depression in Europe and Asia. Furthermore, depression tended to be more frequent among PLWH residing in LMIC compared with HIC, but the difference was not significant. Meanwhile, anxiety was clearly more prevalent among LMIC participants (Table 4); the unequal burden of psychosocial problems in these 2 settings could be related to a higher perceived social judgment and stigma vis-à-vis PLWH in developing countries.[26] Although poverty and psychosocial stress have been associated with an increased risk for substance use,[27,28] our survey found that LMIC residents resorted to recreational substances less frequently than their counterparts in HIC. The reasons underpinning this observation are probably multifactorial, spanning from financial constraints for substance purchase, to the varied sociocultural acceptance of substance use in LMIC.

Besides the disparities in psychosocial well-being, we noted that PLWH in LMIC were younger and were less likely to observe physical distancing than PLWH residing in HIC. These findings reflect the demographic structure and crowded living conditions often encountered in low-income settings.[29] Although a younger population presents a lower risk for COVID-19 morbidity and mortality,[30] preventive measures are still crucial in these communities to limit coronavirus transmission to more vulnerable persons, such as those who are older or with comorbid conditions. Fortunately, the higher rates of mask use reported among PLWH in LMIC may help curb the spread of the disease in these settings where physical distancing is difficult.

Our multivariable model (Table 5) showed that PLWH who had been vaccinated against flu within the 12 months preceding the survey were less likely to experience flu-like symptoms even amidst of the COVID-19 pandemic. Yearly flu vaccination in PLWH is currently internationally recommended.[31] Flu vaccination will reduce the number of PLWH who develop flu-like symptoms and the anxiety generated by these symptoms in the context of a COVID-19 epidemic. It also will reduce the workload of the health care workers because it will decrease the number of suspected cases requiring clinical attention and confirmatory testing. Our findings equally suggest that once the flu-like illness has developed in PLWH, previous flu vaccination has no effects on the prevalence and duration of symptoms (Table 3). Whether the flu shot confers specific protection against COVID-19 is yet to be established.[32]

Our study describes the experiences of PLWH during the ongoing COVID-19 pandemic in a multicountry setting. Nonetheless, our results must be interpreted in light of a number of limitations. This was a cross-sectional survey of the situation during the ongoing pandemic, and it is therefore not possible to know to what extent COVID-19 was responsible for the reported findings. In addition, the web-based nature of our survey introduces an important sampling bias because only individuals of a certain socioeconomic class with access to the Internet and willing to contribute to science will participate. Moreover, it is impossible to verify the veracity of the information provided by the respondents. We also acknowledge that our convenience-based sample size may be small. However, considering the exceptional circumstances imposed by the ongoing COVID-19 outbreak, we are confident our findings still provide useful insights into the realities faced by PLWH during this pandemic.

In conclusion, COVID-19 and associated restrictive measures have adversely impacted the well-being and follow-up of PLWH. It seems that LMIC residents are more affected than those residing in high-income settings. Furthermore, routine flu vaccinations and adaptations of health care systems to ensure continuity of HIV care during the pandemic may minimize the development of flu-like illness among PLWH, thereby reducing personal stress and preventing additional strain on the health care providers. Although more research is needed to confirm these findings, it is important that health systems devise innovative approaches for antiretroviral provision and psychosocial support to PLWH during such outbreaks.[19]

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