(PS1-B35) A Qualitative Exploration of Impacts of COVID-19 Health System Changes on Behavioral Health Among People Living with HIV in South Africa

The COVID-19 pandemic had a large and sudden impact on global health systems and public policy. Particularly in low-resource health systems, governments responded by reallocating resources away from existing services and towards new public health interventions with the goal of reducing demand on the health system. For instance, in South Africa, alcohol sales were restricted to reduce alcohol-related hospital admissions. Understanding patient and other stakeholder perceptions of these shifts may generate important lessons for the future of behavioral health interventions in low-resource health systems. Accordingly, we conducted semi-structured individual interviews with people living with HIV and a co-occurring mental health or substance use problem (n=24) and providers working in HIV care (n=5) in Cape Town, South Africa. Interview guides probed changes in alcohol use during the pandemic, COVID-related changes in HIV care, and any impacts of COVID-related health system changes on mental health. Interviews were conducted virtually using Microsoft Teams in isiXhosa or English and translated and transcribed using Otter.ai. Transcripts were then double coded for key themes, guided by thematic analysis. Four key themes emerged: 1) alcohol sales restrictions helped some participants reduce alcohol use even after sales resumed; 2) most participants saw negative impacts on HIV services (e.g. longer queues and less time with clinicians, reduction in privacy), which negatively affected broader wellbeing and mental health; 3) a few participants perceived positive improvements in HIV services and 4) providers shifting from face-to-face to telephonic mental health counseling experienced barriers to service delivery (e.g. patients not having private space). Findings suggest it is important to further understand patient and other stakeholders’ perceptions of the mental health impacts of the pandemic worldwide, to further examine the potential individual clinical impacts of alcohol and other health policy changes, and to develop strategies for feasible tele-mental health services in low-resource settings globally.