Category: COVID-19 Global Response/Response in Low Resource Settings

Poster Session: COVID-19 Global Response/Response in Low Resource Settings

475 - Describing the impact of the COVID-19 pandemic on HIV care in Latin America

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Presenting Author(s)

Anna K. Person

Associate Professor of Medicine
Vanderbilt University Medical Center
Nashville, TN
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

FM

Fernanda Maruri

Research Coordinator
Vanderbilt University School of Medicine
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EB

Ellen Brazier

Senior Research Scientist
School of Public Health & Health Policy, City University of New York
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JS

Juan G. Sierra Madero

Professor of Medicine
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Mexico City, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VR

Vanessa Rouzier

Assistant Professor of Pediatrics in Medicine
4. Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes
Port-Au-Prince, Centre, Haiti
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GC

Gabriela Carriquiry

Associate Researcher
5. Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia
Lima, San Martin, Peru
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VA

Vivian I. Avelino-Silva

Associate Professor of Medicine
Faculdade de Medicina da Universidade de Sao Paulo
São Paulo, Sao Paulo, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PR

Paulo Ricardo de Alencastro

Researcher
7. Rio Grande do Sul State Department of Health
Porto Alegra, Rio Grande do Sul, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MI

Maria Leticia R. Ikeda

Researcher
8. University of Vale do Rio dos Sinos, São Leopoldo
Sao Leopoldo, Rio Grande do Sul, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RA

Rosa Alencar Souza

Researcher
9. São Paulo State Department of Health
Sao Paulo, Sao Paulo, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SQ

Simone Queiroz Rocha

Researcher
9. STD/AIDS Referral and Training Center-Sao Paulo State Department of Health
Sao Paulo, Sao Paulo, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CC

Carina Cesar

Associate Researcher
10. Fundación Huésped
Buenos Aires, Buenos Aires, Argentina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MW

Marcello Wolff

Professor of Medicine
11. Fundación Arriarán, Universidad de Chile, Facultad de Medicina
Santiago, Region Metropolitana, Chile
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DM

Daisy Machado

Professor of Pediatrics
12. Departamento de Pediatria, Universidade Federal de São Paulo
Sao Paulo, Sao Paulo, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DP

Denis Padgett

Professor of Medicine
13. Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario
Tegucigalpa, Francisco Morazan, Honduras
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JP

Jorge A. Pinto

Professor of Pediatrics
14. Universidade Federal de Minas Gerais
Belo Horizonte, Minas Gerais, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BG

Beatriz Grinsztejn

Professor of Medicine
15. Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz
Rio de Janiero, Rio de Janeiro, Brazil
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CM

Catherine McGowan

Associate Professor of Medicine
Vanderbilt University School of Medicine
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PR

Peter F. Rebeiro

Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The effects of the COVID-19 pandemic on people living with HIV (PWH) are unknown. Beyond SARS-CoV-2 co-infection, the pandemic may have devastating consequences for HIV care delivery. Understanding these is crucial as reduced antiretroviral therapy (ART) availability alone could lead to ≥500,000 AIDS-related deaths in 2020-2021. With Latin America now a focal point in the pandemic, we sought to describe the impact of COVID-19 on HIV care at Latin American clinical sites.

Methods: Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and additional Brazilian HIV care sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru were included. An electronic survey of COVID-19 effects on HIV clinic operations was administered in Spanish or English via phone and email, April 28-June 2, 2020. We also compared national COVID-19 case, mortality, and policy data from public sources.

Results: Brazil’s and Mexico’s epidemics appear most pronounced, with >10,000 confirmed COVID-19-related deaths (Figure 1); countries implemented “social distancing” policies at different times after initial cases, with Haiti earliest and Mexico latest (Figure 2). Nearly all 13 sites reported decreased hours and providers for HIV care. Twelve of 13 reported increased use of telehealth, suspension/postponements of routine HIV appointments, and/or suspension of HIV research. Eleven of 13 reported initiation of new COVID-19 research but suspension of community HIV testing, and nearly half provided additional ART supplies. Nearly 70% reported impacts on HIV viral load testing and nearly 40% reported personal protective equipment stock-outs (Table). All 13 sites experienced changes in resources/services in tandem with national policies; there was wide variation, however, in the number of economic and health supports implemented thus far (e.g., quarantines, tax deferrals, interest rate reductions, etc.), from 172 COVID-19-related policies in Brazil to only 30 in Mexico.Table: Site Assessment of Impacts of the COVID-19 Pandemic on HIV services in Latin America at CCASAnet and Coorte Sites, N=13

Figure 1. Cumulative mortality due to COVID-19 in countries within which CCASAnet and Coorte sites are located Figure 1 footnote: Source for mortality counts: the WHO COVID-19 Dashboard, available at: https://covid19.who.int/ All data were up-to-date as of, and were accessed on, June 17th, 2020

Figure 2. Cumulative cases of COVID-19 in countries within which CCASAnet and Coorte sites are located and dates (relative to the day on which the first positive case of COVID-19 was detected) of general social distancing, public health emergency, or mass quarantine policy introduction (vertical dashed lines), 2020 Figure 2 footnote: Source for case counts: the WHO COVID-19 Dashboard, available at: https://covid19.who.int/ Source for health policy implementation: the United Nations Economic Council for Latin America & the Caribbean, available at: https://cepalstat-prod.cepal.org/forms/covid-countrysheet/index.html All data were up-to-date as of, and were accessed on, June 17th, 2020

Conclusion: The COVID-19 pandemic has already had a substantial effect on daily operations of HIV clinics in Latin America. The downstream effects of these impacts on HIV outcomes in Latin America will need to be further studied.