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Table 3 HIV and Non-HIV Directed Care Challenges

From: The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review

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