{
  "abstract": "Objectives The COVID-19 pandemic threatened global HIV Test and Treat Efforts. We assessed whether it affected (1) the number of antiretroviral therapy (ART) initiations and (2) the proportion of timely ART initiations in people living with HIV (PLWH) globally.Design Quasi-experimental, regression discontinuity design using routinely collected data from HIV clinics.Setting 360 HIV care clinics across primary and secondary levels of care, participating in the International epidemiology Databases to Evaluate AIDS consortium, in 31 countries in Asia, Africa and the Americas.Participants 177 391 PLWH (≥18 years old) who initiated ART 2 years before and 1 year after the onset of the COVID-19 pandemic in their country.Primary and secondary outcome measures The primary outcome was the number of ART initiations per week; the secondary outcome was the proportion of timely ART initiations (ie, ART initiated within 7 days of enrolment). We assessed changes in these outcomes in the 52 weeks after compared to the 104 weeks before the pandemic onset, defined using each country’s peak Oxford Stringency Index score between January and June 2020.Results Among 177 391 newly enrolled PLWH, 129 743 initiated during the pre-pandemic and 47 648 post-pandemic onset. 72.5% of ART initiations were timely pre-pandemic whereas 82.3% were during the pandemic. Absolute number of ART initiations remained stable during the pandemic period in 25 of 31 countries but decreased significantly in six countries: India (−5.0 p, 95% CI −9.2 to −0.7), Rwanda (−10.0 p, −18.6 to −1.4), Malawi (−33.4 p, −54.1 to −12.3), South Africa (−130.8 p, −188.6 to −73.1), Zimbabwe (−12.9 p, −20.0 to −5.8) and Togo (−19.6 p, −39.1 to −0.1). The proportion of timely initiations was stable in all countries except in Kenya (+4.2 pp, 95% CI +0.3 to +8.1) and in Mozambique (+2.7 pp, +0.5 to +4.9), where it increased significantly.Conclusions A deeper understanding of the factors that contributed to sustaining ART initiations, particularly in settings with stringent public health and social measures, is needed. These insights should inform preparedness strategies, resource allocation and policy development to ensure continuity of HIV services during future health emergencies, in line with World Health Organisation recommendations.",
  "authors": [
    {
      "affiliations": [
        "Médecins Sans Frontières Department of Epidemiology and Training, Epicentre, Paris, France",
        "National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, University of Bordeaux, Bordeaux, France"
      ],
      "name": "Jihane Ben Farhat"
    },
    {
      "affiliations": [
        "Programme PACCI/ANRS Research Center, Abidjan, Côte d’Ivoire"
      ],
      "name": "Eugène Messou"
    },
    {
      "affiliations": [
        "BJ Government Medical Center, Pune, India"
      ],
      "name": "Rohidas Borse"
    },
    {
      "affiliations": [
        "Hospital Escuela, Tegucigalpa, Honduras",
        "Instituto de Enfermedades Infecciosas y Parasitarias Antonio Vidal, Tegucigalpa, Honduras"
      ],
      "name": "Diana Varela Bustillo"
    },
    {
      "affiliations": [
        "Desmond Tutu HIV Foundation, Mowbray, South Africa"
      ],
      "name": "Metsekae Madimabe"
    },
    {
      "affiliations": [
        "Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, New York, USA"
      ],
      "name": "Denis Nash"
    },
    {
      "affiliations": [
        "University of Eldoret, Eldoret, Kenya"
      ],
      "name": "Helen Byakwaga"
    },
    {
      "affiliations": [
        "Emory University, Atlanta, Georgia, USA"
      ],
      "name": "N Sarita Shah"
    },
    {
      "affiliations": [
        "Nigerian Institute of Medical Research, Lagos, Nigeria"
      ],
      "name": "Oliver Ezechi"
    },
    {
      "affiliations": [
        "Institute of Infectious Diseases, Pune, India"
      ],
      "name": "Sanjay Pujari"
    },
    {
      "affiliations": [
        "Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil"
      ],
      "name": "Valdiléa G Veloso"
    },
    {
      "affiliations": [
        "SolidarMed, Lucerne, Switzerland"
      ],
      "name": "Michael Hobbins"
    },
    {
      "affiliations": [
        "School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda"
      ],
      "name": "Gad Murenzi"
    },
    {
      "affiliations": [
        "National Institute for Medical Research, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Denna Mkwashapi"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Brenna Hogan"
    },
    {
      "affiliations": [
        "Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea"
      ],
      "name": "Jun Yong Choi"
    },
    {
      "affiliations": [
        "Centre médical de Suivi des Donneurs de Sang, Centre National de Transfusion Sanguine Côte d'Ivoire, Abidjan, Côte d\\'Ivoire"
      ],
      "name": "Albert Minga"
    },
    {
      "affiliations": [
        "Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico"
      ],
      "name": "Brenda Crabtree-Ramírez"
    },
    {
      "affiliations": [
        "Centre National de Référence en matière de VIH/SIDA (CNR), Bujumbura, Burundi"
      ],
      "name": "Christella Twizere"
    },
    {
      "affiliations": [
        "Immune Suppression Syndrome Clinic, Mbarara, Uganda"
      ],
      "name": "Lameck Diero"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Jason Haw"
    },
    {
      "affiliations": [
        "Center for Infectious Disease Research, Lusaka, Zambia",
        "Infectious Disease, University of Alabama, Birmingham, Alabama, USA"
      ],
      "name": "Carolyn Bolton-Moore"
    },
    {
      "affiliations": [
        "Fundación Arriarán, Santiago, Chile",
        "University of Santiago de Chile School of Medicine, Santiago, Chile"
      ],
      "name": "Claudia P Cortes"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital, Birmingham, UK"
      ],
      "name": "Man-Po Lee"
    },
    {
      "affiliations": [
        "Lighthouse Trust, Lilongwe, Malawi"
      ],
      "name": "Safari Mbewe"
    },
    {
      "affiliations": [
        "Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, New York, USA"
      ],
      "name": "Ellen Brazier"
    },
    {
      "affiliations": [
        "Department of Medicine, Indiana University, Indianapolis, Indiana, USA"
      ],
      "name": "John M Humphrey"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Keri N Althoff"
    },
    {
      "affiliations": [
        "National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, University of Bordeaux, Bordeaux, France",
        "Service de Médecine Interne et Maladies Infectieuses, CHU de Bordeaux, Bordeaux, France"
      ],
      "name": "Fabrice Bonnet"
    },
    {
      "affiliations": [
        "Institut Pascal (UMR 6602), Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont-Ferrand, France"
      ],
      "name": "Diana Barger"
    },
    {
      "affiliations": [
        "National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, University of Bordeaux, Bordeaux, France"
      ],
      "name": "Antoine Jaquet"
    },
    {
      "affiliations": [],
      "name": "IeDEA International epidemiology Databases to Evaluate AIDS"
    }
  ],
  "title": "Effect of COVID-19 pandemic on ART access and timely initiation in people living with HIV in 31 countries: a regression discontinuity design study",
  "uid": "61cd6cb0-3815-59b3-8e4b-b9b9bcd030f0"
}