The COVID-19 pandemic and associated lockdowns threaten to diminish gains made with respect to HIV epidemic control. The impacts are likely to be most profound among marginalized key populations in resource-limited settings.
Beginning in 2013, we initiated integrated care centers (ICCs) targeting PWID and MSM; ICCs are currently active in 16 Indian cities (8 PWID, 8 MSM) providing core and population-focused HIV services, including HIV counseling/testing, STI testing, and linkage to/monitoring of ART from government facilities. To understand the pandemic’s impact on service access, we compared service utilization among ICC clients early in the pandemic (March-July 2020) to pre-pandemic (Jan-Feb 2020) levels. Specifically, we assessed: 1) numbers of clients accessing HIV testing and STI screening as well as new HIV diagnoses, and 2) for HIV-infected clients on ART in December 2019, the medication possession ratio (MPR). The MPR is the percentage of days in a month that a client had an available dose of ART based on the client’s government ART book.
Overall, 14,415 clients visited an ICC from Jan-July 2020. Compared to pre-pandemic levels, the total number of clients receiving services at the ICC began declining in March and dropped to ~25% normal capacity in May and only returned to ~35% capacity by July. HIV testing declined by 88% beginning in mid-March (PWID 90%, MSM 84%) followed by a modest increase in April/May, but levels did not return to pre-pandemic levels (Figure panel A); a similar pattern was seen for STI testing. HIV diagnoses had a sharp decline in March/April with no significant rebound to pre-pandemic levels by July; among MSM there was only one new diagnosis in all of April-July, compared to ~30 each month in January and February. Compared to February, the median MPR in April declined by nearly 60% for PWID (from an MPR of 97% to 40%) and by 20% for MSM (100% to 80%). The MPR continued to fall for PWID reaching a nadir of 16% in July; by contrast the MPR climbed back to near pre-pandemic levels for MSM by July (Figure panel B).
The COVID-19 pandemic has led to significant decreases in use of HIV-related services among key populations in India. PWID have fared substantially worse than MSM in both preventive and treatment services. This presents an opportunity for increased transmission and incidence among groups that are already disproportionately impacted by the HIV epidemic.
