HIV directed care challenges | Non-HIV directed care challenges | |||||||
---|---|---|---|---|---|---|---|---|
ID | Medication | Appointments | Health care | Viral Suppression | Other | Mental health care | Alcohol and substance abuse care | Other |
1 | Difficulty obtaining HIV medication (3.9%), Under average adherence to antiretrovirals (1.7%) | NA | Inability to access telehealth technology (34.7%) | NA | NA | Disruption in mental health services (11%) | Disruption in substance abuse care services (1.3%) | Difficulty obtaining other medication (9.1%) |
2 | No change in adherence to antiretrovirals | Increased interruption of virological follow-up in 2020 (12.9%) [half of them continued obtaining medication] / Decreased routine in-person appointments | NA | Progressive increase of virological suppression rate, a Decreasing trend of virological determinations ≥ 50 copies/mL during the pandemic | NA | NA | NA | NA |
3 | Decreased adherence to medication (from 5 to 12%) | Decreased attendance to recovery support meetings, Decrease in confidence to keep next HIV appointment | NA | NA | NA | NA | No difference in the proportion of people using alcohol (41%) or marijuana (32%), Increase utilization of illicit substances (including heroin, cocaine, sedatives, prescription opioids, or methamphetamine) (8%) | NA |
4 | 23.1% decrease in obtaining medication during the pandemic. [higher in females and non-Italians] | Increased missing HIV clinic visits [higher in females] | Started using telemedicine (67.3%) | NA | Increase in the number of hospitalizations in HIV + patients | NA | NA | NA |
5 | Increased mail delivery for prescriptions and extended refills | visits during the pandemic: 2.0% attended in-person, 21.4% attended virtual visits, and 30.6% rescheduled for a later date. [rescheduled or canceled visits were associated with lower viral loads]/ | NA | NA | The difficulty oflaboratory testing | Increased therapy session | NA | NA |
6 | No changes in antiretroviral adherence or health care utilization. [8% missed at least one dose and 13% avoided picking up ART due to the pandemic] | Missed an appointment in the past month (6.0%) [54.6% due to cancellations] | Avoided health care in the past month (20.2%) | NA | NA | NA | Reduced cocaine use and cigarette smoking | NA |
7 | No change (uncertain) in adherence to medication, Decreased obtaining medication and less refill during and post lockdown, No change in consistency of daily pill-taking timing, Missing a dose of ART (12.1%) [due to food insecurity during the lockdown] | Decreased clinic visits during lockdown [46% decreased compared to last year] | NA | No reduction with a slight increase in viral suppression (90%) | NA | NA | NA | NA |
8 | Temporarily non-adherent due to finishing off ART stock (36%) [presence of family improved the condition] | Difficulty visiting clinics [due to inadequate transport, police abuse, and insufficient transportation funds to avoid exposure to COVID-19] | NA | NA | Declined courier home delivery due to stigma | NA | NA | Covid care concerns regarding stigma and discrimination associated with HIV |
9 | No change in adherence, Run out of medication (13.25%) | Missed an appointment (15.66%) | Missed the community health worker's support (69.88%) | NA | NA | Depression (29%) | NA | Decrease in reporting violence (emotional, physical, sexual) |
10 | Missed visits for a refill (27.4%) [predicting factors: age ≥ 55, fear of COVID-19, transport disruption, reduced income for traveling to the health facility, and limited access to mask, sanitizer, and non-medical support] | Missed follow-up tests (26.4%), Missed counseling services (25.9%) | NA | NA | NA | NA | NA | NA |
11 | Stopped taking ART (3%) | Fear of visiting the hospital (48%) | NA | NA | NA | NA | NA | NA |
12 | Missed a dose of HIV medications (24.0%). [associated with disruption of access to health care, missed appointment, and PTSD] [younger respondents were more likely to report missed HIV medication doses] | Missed appointment (46.0%) | NA | NA | NA | Changes in sleep patterns (54.0%), Feeling anxious (56.0%), Frustrated (50.0%), Depressed (41%), Bored (43.0%) | NA | NA |
13 | No change in obtaining HIV medications, Difficulty adhering to medication regimens | Challenges with virtual appointments | Difficulty accessing medical care in the context of COVID-19 | NA | NA | NA | NA | NA |
14 | Unable to refill their ART (3.6%) | Unable to meet their HIV physician face-to-face (55.8%) | NA | NA | NA | Anxiety and depression (27.9%), Anxiety and depression (19.8%), Need for psychosocial support (40.1%) | Increased recreational drug use (8.6) | NA |
15 | Providers reported ART application service was suspended or postponed because of COVID-19 (67.25%), Providers reported ART provision was suspended or postponed due to the short supply (0.49%) | NA | Providers reported HIV clinic service was suspended because of COVID-19 (5.05%), Reported voluntary counseling and testing service was suspended or postponed (53.94%), Reported outreach work was suspended or postponed (34.11%), and reported follow-up service was suspended or postponed (7.39%) | NA | NA | NA | NA | NA |
16 | NA | Most HIV clinics: Reduced their office hours, limited office visits, and limited face-to-face appointments, seven clinics were closed with only staff checking emails daily | HIV related services were interrupted at many clinics (scope and delivery), Two HIV clinics reported discontinued home visits and support groups, Several clinics suspended walk-in services, their Inability to timely shift to a telehealth system, and HIV clinics: were partially interrupted (56%) or completely closed (26%) | NA | Most of the clinics still provided core HIV services (e.g., medicine refilling, HIV testing), Suspended or canceled face-to-face counseling, and social support groups | NA | NA | NA |