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COVID-19 and associated disruptions may indirectly affect HIV outcomes in two capital cities in Western/Central Africa: a modelling study

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BACKGROUND: HIV prevalence has declined in Cotonou (Benin) and Yaoundé (Cameroon) following the scale-up of HIV prevention/treatment (40% of people living with HIV are virally suppressed) and increases in condom use. The COVID-19 pandemic and responses to it may disrupt HIV services such as antiretroviral therapy (ART) delivery and condom distribution, but this negative impact could be attenuated by temporary decreases in sexual risk behaviours due to compulsory social distancing or reduced access to commercial sex. We explored the potential effects of these changes on HIV outcomes in the two cities.
METHODS: We used deterministic mathematical models of HIV transmission calibrated to available city-specific demographic, behavioural, and HIV epidemic data. We calculated the relative difference in 1-year cumulative new HIV infections and HIV-related deaths (median, 95% uncertainty interval), between a base-case scenario assuming no COVID-19 and combined scenarios assuming no ART initiations, a 10/25/50% reduction in HIV prevention/treatment services, and decreased numbers of casual/commercial sexual partnerships over a 6-month period.
RESULTS:


An estimated 50% increase in new HIV infections (Figure, panels a-b) and 20% increase in HIV-related deaths (Figure, panels c-d) would be induced by combined 6-month 50% reductions in HIV prevention/treatment use (red boxes). The estimated increase in new HIV infections would be much lower (2-fold in Yaoundé, 3-fold in Cotonou) but still substantial (20-30%) if 50% decreases in casual/commercial partnerships occur, with the impact on HIV-related deaths remaining high (dark-blue boxes). The estimated impact on new infections and HIV deaths is similar in the two cities but uncertain.


CONCLUSIONS: A temporary reduction in HIV prevention/treatment services may have substantial impact on HIV outcomes in these two West/Central African cities, which would only be partially offset by people having fewer casual and commercial sexual partnerships. It is important that HIV prevention/treatment services are sustained during the COVID-19 pandemic.