Impact Mitigation of COVID-19 Pandemic on Pediatric HIV Care

To the Editor: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) pandemic has disrupted normal lives. Its emergence has created another health burden for children and adolescents living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (CLHIV). Recently, the CDC has highlighted that people living with HIV (PLWH) are at increased risk for severe physical health illness from coronavirus disease 2019 (COVID-19) [1]. Due to disruptions caused by COVID-19, delivery of effective healthcare and access to HIV treatment was anticipated to be adversely affected. We, herein share experience at our pediatric antiretroviral therapy (ART) center to explore the potential impact of COVID-19 on HIV care.

To contain spread of SARS-CoV-2 India imposed lockdown on March 24, 2020. National AIDS Control Organization (NACO) guidelines were received regarding administering local level mechanisms for decentralization of services. There were 323 active cases of CLHIV under care before the lockdown and 10 clients (3.1%) were nonadherent, while after the lockdown, 46 clients (14.2%) were nonadherent in April, 2020 and another 27 clients (8.3%) missed drugs in May, 2020 (p value < 0.0001 for March–April and p value = 0.0044 for March–May). Thus, despite decentralization of services, HIV care in CLHIV was significantly affected by the lockdown with a significant improvement from April to May 2020 (p value = 0.0177).

Syndemic interactions between COVID-19 and HIV may interfere with HIV services. Effect of global pandemic ultimately falls among vulnerable groups of low- to middle-income countries [2, 3]. CLHIV need regular access to healthcare to maintain viral suppression providing optimal clinical benefits and reducing HIV transmission [4]. Strategies to tackle COVID-19 pandemic (staying home, avoiding group gatherings/functions, social distancing, and hand washing) pose unique challenges to HIV care. So there was a need of adapting mode of service delivery. Decentralization was successful to some extent at our center. Innovative replication and adaptation of this approach will be helpful in optimal HIV care delivery services across different settings.

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