While little is known about the interaction of HIV and SARS-CoV-2, disruptions caused by the COVID-19 pandemic may impact the ability of people living with HIV (PLHIV) to access antiretroviral therapy (ART). We conducted syndromic surveillance to identify challenges in PLHIV’s access to health care services in selected districts in Malawi.
We conducted telephone-based syndromic surveillance among randomly selected PLHIV ?18 years old who had a telephone number on file in 179 ART clinics across nine districts. Patients who answered the phone were asked to verify their identity and provide consent. Staff used a structured questionnaire to collect self-reported data on demographic characteristics, experience of COVID-19 symptoms (CS) within the past 14 days as defined by the World Health Organization, access to health services, and ART interruptions (?1 dose missed in past week) during the pandemic. We summarized data using proportions and medians and used Chi-square tests to examine associations.
From August-October 2020, we dialed 17,944 numbers; 26.1% (4,680) confirmed their identity, were on ART and were ?18 years. Most (93.7%, n=4,385) eligible clients consented, and 98.6% (n=4323) completed interviews. Over half (53.8%) were female. The male median age was 42 years (interquartile range [IQR] 18 – 78) compared to 36 (IQR 18 -80) among females. Of 263 (6.1%) reporting at least one CS, persistent cough (35.7%), headache (40.3%) and fever (18.6%) were most common. Overall, 193 (4.5%) reported having been tested for SARS-CoV-2. Females were more likely to have missed school or work due to CS compared to males (37.3% vs. 21.8%, p=0.004), and were more likely to access medical care for CS (66.2% vs. 54.9%, p=0.048). Of all respondents, 17.6% reported not accessing health care services during the pandemic. Challenges included health facility closures (13.6%), no money for transport (13.9%) and fear of COVID-19 (45%). Few respondents (1.8%) reported missing ART doses.
The telephone-based syndromic surveillance system proved to be feasible in monitoring the impact of COVID-19 among PLHIV in a resource-limited setting. PLHIV reported missing school or work due to CS and not accessing health care services, though few missed their ART doses; these findings require further research. Similar systems can be used to rapidly identify and respond to COVID-19-related challenges with health care access for people on ART.