Although the global focus is dominated by COVID-19, the HIV AIDS pandemic is far from over as it enters its fifth decade. Since the early 1980s, 75.7 million people have got infected with HIV. 32.7 million people have died of AIDS-related ailments. HIV/AIDS remains a significant public health crisis, and only a few states will meet the 90–90–90 treatment goal for 2020.
Much was made of how information systems and support models in the HIV response have helped the COVID-19 response, but the COVID-19 pandemic might have knock-on impacts on the HIV response and be disastrous for communities. How might the COVID-19 outbreak shape the future HIV/AIDS response towards attaining the objective of finishing HIV/AIDS by 2030?
The COVID-19 pandemic has stressed health systems and exposed gaps in Public health nearly everywhere. From the highest federal leadership levels to community-based health centers, human, fiscal, and research tools are diverted from HIV efforts.
Most health systems in areas with a high HIV burden are delicate, and several studies indicate that disruptions to HIV services may have adverse impacts on health effects in the medium and long term. Modeling data released show that acute treatment disruptions in high-burden facilities could increase HIV mortality by 10% over five years. The HIV Modelling Consortium has demonstrated that acute treatment disturbances in sub-Saharan Africa.
UNAIDS models indicate that 6-month interruptions to services for mother-to-child transmission of HIV could increase new infections among children by 40–80 percent in high-burden nations.
While HIV prevention, testing, and maintenance have been disrupted in most countries due to strict lockdown policies and fractures in medication supply chains. UNAIDS states the consequences of COVID-19 on claiming treatment solutions have been less severe than initially feared. As a result of novel approaches, such as home deliveries of medications and digital platforms for virtual patient assistance, HIV prevention services have rebounded in several communities.
A chilling pattern of inequity contours the load of COVID-19 and HIV. The adverse effects of each disease are influenced by economic and social disparities and disproportionately affect poor and marginalized people–young women and girls in particular. The socioeconomic impacts of this COVID-19 pandemic will be far-reaching and long-lasting.
The World Bank alerts that 115 million people were pushed to intense poverty in 2020. COVID-19 is also poised to grow inequity because pandemic-related job deprivation and losses affect poor and helpless people most significantly. Poverty could cause further barriers to participating in the HIV care system.
Dec 1, 2020, was World AIDS Day. Against the backdrop of a huge health crisis, this year’s campaign calls for international solidarity and joint responsibility. To health leaders confronting many competing priorities, what might this entail in practice?
Made on the AIDS movement’s commitment to human rights, health equity, and gender equality, this new age could develop strong, flexible, people-centered health programs, achieve universal health care, and address the structural and social determinants of health. The Global Fund to Fight AIDS, Tuberculosis, and Malaria embraced a systems-strengthening approach in 2016.
For other associations that have been instrumental in the AIDS response, this outlook should indicate that fragmented, siloed approaches are substituted with the broader health system strengthening and preparedness that incorporates HIV along with other health priorities.
The Integration Of HIV With Covid-19 Is Currently Happening
COVID-19 has compelled many countries to accelerate the scale-up of distinguished service delivery for HIV by facilitating multi-month dispensing of HIV medication, which they otherwise might not have done. COVID-19 is imperiling HIV services and forcing health systems to accommodate.
But adaptations need not necessarily be harmful. Exploring opportunities to prioritize people-centered strategies could enable patients to deal with issues like stigma, discrimination, and poverty, along with reducing contact with health centers and so freeing up capacity. This kind of approach is necessary to rejuvenate the HIV response and end the HIV pandemic back on track.
We understand that the COVID-19 pandemic is causing much doubt worldwide, including people living with and affected by HIV.
How COVID-19 affects people living with HIV isn’t fully known yet. At present, there’s no evidence suggesting that there’s a higher risk of disease and increased severity of illness for individuals living with HIV (with the understanding they’re not immunosuppressed and/or don’t have another co-infections or co-morbidities). But people living with HIV that aren’t on treatment or who aren’t virally suppressed might have a weak immune system (measured by a low CD4 count), which makes them vulnerable to opportunistic infections and more severe illnesses.
It’s thought that individuals living with HIV who have attained viral suppression via antiretroviral therapy and don’t have a very low CD4 count will be impacted by COVID-19 in a similar way to what a person not suffering from HIV would be, according to additional coronavirus-caused disease outbreaks like SARS (due to SARS-CoV-1) and MERS (due to MERS-CoV), where just a few cases of mild disease among people with HIV were reported.
- People with HIV are recommended to take the same precautions as the general population and adhere to their particular government recommendations. Things individuals can do to protect themselves and others from COVID-19 include:
- Normal hand-washing with water and soap for at least 20 minutes.
- Cover your nose and mouth with a tissue, use your sleeve or elbow (not your hands) when you cough or sneeze.
- Throw any used tissues into the garbage bin immediately.
- Avoid touching nose, eyes, or mouth with unwashed hands.
- Steer clear of work, college, public spaces, and others if you get ill.
- Keep taking your HIV medication regularly, as prescribed, to maintain your immune system as strong as you can.
- People with HIV who know their status and aren’t yet on antiretroviral treatment should begin treatment without delay.
If you need to get health services, it is recommended to follow national advice and, where possible, call your health care provider before arriving at a health facility. Moreover, measures should be taken to ensure appropriate disease control and follow advice on physical distancing.
People with HIV who are on therapy should ensure that they have 30 days of ARVs together and, where possible, a 3 to 6 month supply of ARVs. Get more information on strategies for expanding the term of ART refills and reducing contact with health centers.
People living with HIV should remain socially connected with networks and communities using technology where possible and handle any stress or anxiety with friends and their health care provider.
There’s no proof that PrEP prevents you from getting COVID-19 or that it can allow you to recover quicker if you use PrEP.
Presently, there is insufficient data to assess the effectiveness of any sort of antiretroviral for treating COVID-19. The latest study issued in the New England Journal of Medicine revealed that a combination of ritonavir and lopinavir — both antiretrovirals used to treat and protect against HIV — wasn’t correlated with clinical improvement or mortality in severely ill patients with COVID-19 compared to standard of care alone.
Whether earlier treatment or alternative mixtures of antiretrovirals and other medications could have clinical benefit is an important one that needs further research. A Journal of the International AIDS Society (JIAS) article systematically analyzed the clinical outcomes of using antiretroviral drugs to prevent and treat coronaviruses and planned clinical trials.
Up to now, there’s absolutely no antiviral medication to prevent or cure COVID-19. Potential vaccines and a few particular antiviral treatments that hit the SARS-CoV-2 virus itself, along with remedies to ease the respiratory difficulties of critical disease (for example, leronlimab), are under investigation as part of clinical trials. The World Health Organization coordinates efforts to develop new vaccines and medications and test existing medicines’ effectiveness to treat and prevent COVID-19.
Current clinical data suggest that elderly people and people with other co-morbidities, including cardiovascular disease, diabetes, chronic respiratory disease, and hypertension, appear to create considerable COVID-19 illness compared with other people.
If you live with HIV and are elderly and/or have other co-morbidities, like the ones listed above, you must continue taking any prescribed chronic medicine.
While there is no specific data yet on how COVID-19 affects people co-infected with HIV and TB, individuals living with HIV who live with TB or TB survivors frequently have lung damage. They, therefore, may be more prone to COVID-19 and might develop severe illness. People with TB and HIV co-infection or are pulmonary TB survivors most likely to have damaged lungs should pay special attention to advice on infection control practices, like physical distancing.
Given that pulmonary COVID-19 and TB affect the lungs, Higher TB Burden countries will have to protect people with TB and TB survivors from SARS-CoV-2 exposure to differentiate between those with a respiratory disease brought on by TB COVID-19, which might call for different clinical management.
People with HIV who are on treatment should ensure that they have 30 days of ARVs together and, where possible, 3 to 6 weeks supply of ARVs.
Ahead of the COVID-19 outbreak, the World Health Organization currently recommended that clinically older adults, children, adolescents, and breastfeeding and pregnant women, in addition to members of essential populations (men who have sex with men, sex workers, and transgender people), and people who inject drugs, could benefit from multi-month prescriptions and refills.
Multi-month refills are where health professionals prescribe 3-6 weeks of HIV medication to decrease the frequency of visits to clinical settings. With more prescriptions, people living with HIV can get longer ART refills and/or get ART refills from community-based services. This may limit unnecessary visits to healthcare facilities, thereby reducing the probability of SARS-CoV-2 exposure and decreasing the probability of treatment interruption, despite potential lockdowns and disruptions to practice programs throughout the COVID-19 outbreak.
Individuals who think they may have been exposed to HIV should get tested and seek medical advice whenever possible. Some countries are increasing HIV self-testing in this time, and several clinics are now requesting clients to call before, so please follow the neighborhood health services’ advice.
While financing, researchers and health care workers are being diverted To operate on COVID-19, essential health services must remain available to individuals living with and affected by HIV to protect against HIV disease progression and complications in any other co-infections or co-morbidities, such as some widespread chronic conditions like diabetes and hypertension.
To reduce the impact of COVID-19, where possible, services should be provided through telemedicine, multi-month refills of chronic medications made available and sent via postal services, and other advanced tools implemented more broadly, including HIV self-sampling and self-testing using ready sampling kits and sending protected specimens safely. Telemedicine for first symptom screening and triage and psychosocial support may be crucial to ease physical distancing and disease control without affecting care standards.
The international response to support the COVID-19 pandemic may also influence health product supply chains, including shipping and logistics. The Global Fund is working closely with providers and partners to evaluate the effect on core health product, provides and supply recommendations for implementing partners about the best way best to manage that impact.
The international health community is tracking the COVID-19 pandemic and ensuring healthcare systems, supply chains, and communities are ready. This is particularly significant in resource-limited configurations with high burdens of HIV and other chronic co-infections and co-morbidities, particularly sub-Saharan African.
Previous outbreaks have shown that if health systems are flooded, deaths from vaccine-preventable and other treatable conditions may also increase dramatically, such as those associated with HIV and AIDS, and TB. Countries will have to balance reacting directly to the COVID-19 pandemic while preserving essential health services. WHO has issued updated guidance on a set of targeted immediate actions that nations should consider at regional, national, and local level to reorganize and maintain access to high-quality essential health services for everybody.
Along with preserving essential healthcare services, authorities must support those most vulnerable, including the homeless and people living in informal settlements, to guarantee access to shelter, food, and clean water, particularly during government-enforced movement constraints.
For physical distancing, policies need to be set up that limit individual living with HIV to visit a health facility. Health facilities have to be set up in ways that encourage appropriate training and disease control measures.
Where possible, random visits to health centers for people living with HIV ought to be reduced. For example, if someone gets an HIV Positive diagnosis, they should be encouraged to instantly initiate ART on the day of diagnosis to reduce unnecessary follow-up appointments. People living with HIV on treatment should be sure they have a minimum of 30 days of ARVs together, where possible, a 3 to 6 month supply of ARVs.