In 2019, UNAIDS estimated there were 150,000 new HIV infections among children (<15 years old) and 170,000 among adolescents (10-19 years old), highlighting the ongoing need for HIV testing and diagnosis among these populations. We aim to describe the impact of COVID-19 on HIV testing and diagnosis in children and adolescents.
We analyzed U. S. President’s Emergency Plan for AIDS Relief (PEPFAR) Monitoring, Evaluation and Reporting (MER) data from 14 countries in sub-Saharan Africa to compare the number of children (1-14) and older adolescents (15-19) who received an HIV test and were diagnosed as HIV-positive before (January – March, 2020) and during (April – June, 2020) the COVID-19 pandemic across all HIV testing modalities and for index testing (i.e. exposure-based). We calculated the percent change for the two indicators in the two time periods.
Overall, pediatric HIV testing and diagnoses declined by 40% and 29%, respectively, across the 14 countries. The testing decline ranged from -13% (DRC) to -81% (Zimbabwe) with the greatest volume of decline in South Africa (-150,469). Lesotho (-61%), Zimbabwe (-57%) and South Africa (-53%) had the largest declines in HIV diagnoses. Pediatric HIV testing and diagnoses increased in Cameroon, 32% and 6%. Pediatric index testing declined by 33% overall with the largest declines in Malawi (-80%) and Lesotho (-66%) and increases in Cameroon (+74%). For older adolescents, HIV testing and diagnoses declined 28% and 29%, respectively, across modalities. Lesotho (-60%), Zimbabwe (-54%) and Ethiopia (-48%) had the largest declines in testing for this group with the greatest volume of decline in South Africa (-147,891). Seven countries had >25% declines in HIV diagnoses for older adolescents, with Lesotho (-50%) and Zimbabwe (-49%) having the largest declines. While index testing for older adolescents decreased in most countries (-31%), it increased in Cameroon (+25%), Nigeria (+20%) and Côte d’Ivoire (+15%).
Pediatric and adolescent HIV testing and diagnoses dramatically declined in many sub-Saharan African countries during the COVID-19 pandemic. Countries – like Cameroon, Côte d’Ivoire and Nigeria – that maintained or increased index testing during COVID-19 had the lowest declines in case finding. To mitigate the effects of COVID-19, programs may consider strategies to maximize index testing for children and adolescents (<19) of people living with HIV.