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  • Title: Service Interruption in HIV Care Amid COVID-19 Pandemic in Myanmar: Results From Analysis of Routine Program Data 2018-2022.
    Author: Khaing M, Lwin S, Paw N, Htet Z, Htet L, Ko H, Thet M.
    Journal: J Int Assoc Provid AIDS Care; 2024; 23():23259582241299466. PubMed ID: 39648608.
    Abstract:
    BACKGROUND: COVID-19 pandemic disrupted organized HIV screening efforts, HIV testing and management worldwide, and the impact of these disruptions from private HIV care clinics have not been examined in Myanmar. PSI/Myanmar had adapted through partner clinics, Sun Quality Health Clinics (SQH) and Lan Pya Kyel clinics (LPK), with measures like online booking, staff scheduling and awareness campaigns. The purpose of this paper was to describe whether HIV-related services changed before, during, and after the COVID-19 pandemic in Myanmar. This study aimed to identify factors influencing ART retention and VL testing. METHODOLOGY: Data from 43 healthcare facilities across 8 regions (2018-2022) was analyzed for HIV indicators, including HIV tests, positive cases, ART retention, viral load (VL) testing, and suppression rates in two channels during different phases. RESULTS: During the COVID-19 pandemic, both Channel 1 (SQH) and Channel 2 (LPK) showed fluctuations in HIV testing and new positive cases. Channel 1 had 28.2% decrease in testing (37 735 fewer tests) while Channel 2 had 8.1% increase (81 596 tests). However, testing numbers continued to decline. ART retention declined over 12 months compared to 6 months for both channels. Channel 1 had a slight drop in 6-month retention during the crisis (89.3-88.1%) but an increase in 12-month retention after. Channel 2 maintained high 6-month retention rates (>90%) but varied in 12-month rates (from 80.1% to 92.9%). Unsuccessful outcomes were more common at 12 months in both channels (4.7-21.8% in Channel 1; 7.1-19.9% in Channel 2). VL testing at 12 months significantly decreased during the crisis, notably in Channel 2 (81.9-1.3%). However, high rates of VL suppression (>91%) were consistently seen in those tested in both channels before, during, and after COVID-19. Univariable and multivariable cox proportional hazards models were used to identify factors influencing ART retention. Univariable and multivariable logistic regression analyses were done for VL testing. Factors such as residence location, the period of COVID-19, use of second-line ART, and patient demographics (such as age and key population type) influenced both. Specifically, individuals seeking care from Mandalay [aHR = 1.37, P value < 0.01], and enrolled for ART during or after COVID-19 [aHR = 3.31, P value < 0.01], were more likely to be retained at 12 months. VL testing was positively associated with having no TB [aOR = 1.35, P value < 0.01], being MSM [aOR = 1.69, P value < 0.01], PWIDs [aOR = 2.51, P value < 0.01], and seeking care at Channel 2[aOR = 1.76, P value < 0.01]. CONCLUSION: The study highlighted interruption in ART retention and VL testing because of the COVID-19 pandemic, emphasizing the need to maintain essential HIV services and address gaps based on patient demographics, clinic type, ART enrollment period, and location. Certain factors played a role in influencing these outcomes, providing insights into potential areas for improvement in HIV care and treatment during similar crisis situations to ensure consistent and effective HIV care. Why Was the Study Done?The COVID-19 pandemic disrupted HIV testing and treatment services worldwide. However, the impact on private HIV clinics in Myanmar has not been well studied. This study identified the extent to which HIV-related services had been affected by the COVID-19 pandemic in Myanmar and how we could overcome these challenges.What Did the Researchers Do?The clinics adapted by implementing measures like online booking, staff scheduling changes, and awareness campaigns. The study looked at HIV program data from 43 healthcare facilities across 7 regions from 2018 to 2022, and the following HIV indicators: number of HIV tests done, positive HIV cases identified, ART retention, viral load (VL) testing, HIV viral suppression, were explored. The data was divided into two channels and different COVID-19 periods to see how these HIV services changed.What Did the Researchers Find?It addressed a gap in existing studies by providing quantitative evidence from private clinics in Myanmar, shedding light on the impact of the pandemic on HIV-related care. The number of HIV tests done, and new HIV cases found fluctuated during the COVID-19 pandemic in both channels. ART retention declined at 12 months compared to 6 months in both channels. Unsuccessful treatment outcomes were more common at 12 months, while viral load (VL) testing significantly decreased during the crisis, especially in Channel 2. However, VL suppression rates remained high (>91%) in both channels. Factors influencing ART retention and VL testing included seeking care from Mandalay, initiating ART during or post-COVID-19, using second-line ART, and demographic variables such as age and belonging to key populations (MSM, PWID).What Do the Findings Mean?Despite declines in viral load monitoring and treatment retention, it highlighted opportunities for improvement: multi-month medication supply, online counseling, and booking systems. The findings advocated for improvement in HIV care and treatment during similar crisis situations in the future.
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