Service Interruption in HIV Care Amid COVID-19 Pandemic in Myanmar: Results From Analysis of Routine Program Data 2018-2022.

Abstract

Background: COVID-19 pandemic disrupted organized HIV screening efforts, HIV testing and management worldwide, and the impact of these disruptions from private HIV care clinics have not been examined in Myanmar. PSI/Myanmar had adapted through partner clinics, Sun Quality Health Clinics (SQH) and Lan Pya Kyel clinics (LPK), with measures like online booking, staff scheduling and awareness campaigns. The purpose of this paper was to describe whether HIV-related services changed before, during, and after the COVID-19 pandemic in Myanmar. This study aimed to identify factors influencing ART retention and VL testing.

Methodology: Data from 43 healthcare facilities across 8 regions (2018-2022) was analyzed for HIV indicators, including HIV tests, positive cases, ART retention, viral load (VL) testing, and suppression rates in two channels during different phases.

Results: During the COVID-19 pandemic, both Channel 1 (SQH) and Channel 2 (LPK) showed fluctuations in HIV testing and new positive cases. Channel 1 had 28.2% decrease in testing (37 735 fewer tests) while Channel 2 had 8.1% increase (81 596 tests). However, testing numbers continued to decline. ART retention declined over 12 months compared to 6 months for both channels. Channel 1 had a slight drop in 6-month retention during the crisis (89.3-88.1%) but an increase in 12-month retention after. Channel 2 maintained high 6-month retention rates (>90%) but varied in 12-month rates (from 80.1% to 92.9%). Unsuccessful outcomes were more common at 12 months in both channels (4.7-21.8% in Channel 1; 7.1-19.9% in Channel 2). VL testing at 12 months significantly decreased during the crisis, notably in Channel 2 (81.9-1.3%). However, high rates of VL suppression (>91%) were consistently seen in those tested in both channels before, during, and after COVID-19. Univariable and multivariable cox proportional hazards models were used to identify factors influencing ART retention. Univariable and multivariable logistic regression analyses were done for VL testing. Factors such as residence location, the period of COVID-19, use of second-line ART, and patient demographics (such as age and key population type) influenced both. Specifically, individuals seeking care from Mandalay [aHR = 1.37, P value < 0.01], and enrolled for ART during or after COVID-19 [aHR = 3.31, P value < 0.01], were more likely to be retained at 12 months. VL testing was positively associated with having no TB [aOR = 1.35, P value < 0.01], being MSM [aOR = 1.69, P value < 0.01], PWIDs [aOR = 2.51, P value < 0.01], and seeking care at Channel 2[aOR = 1.76, P value < 0.01].

Conclusion: The study highlighted interruption in ART retention and VL testing because of the COVID-19 pandemic, emphasizing the need to maintain essential HIV services and address gaps based on patient demographics, clinic type, ART enrollment period, and location. Certain factors played a role in influencing these outcomes, providing insights into potential areas for improvement in HIV care and treatment during similar crisis situations to ensure consistent and effective HIV care.