Assessing the effects of the COVID-19 pandemic on new ART initiation and viral load access among children and adolescents living with HIV in West Africa: an interrupted time series analysis

Rodion KONU^1*Karen Malateste²Sophie Desmonde³Désiré Lucien Dahourou⁴Madeleine Amorissani-Folquet⁵Mariam Sally⁶Caroline Yonaba⁷Lehila Tossa-Bagnan⁸Joycelyn Assimeng Dame⁹Didier Ekouevi¹Valeriane Leroy³

• ¹Département de santé Publique, Université de Lomé, Lomé, Togo
• ²Université de Bordeaux, Institut national de la recherche médicale (Inserm) UMR 1219, Institut de recherche pour le développement (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
• ³UMR1295 Centre d'Epidémiologie et de Recherche en santé des Populations (CERPOP), Toulouse, France
• ⁴Département Biomédical et de Santé Publique, Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
• ⁵Centre hospitalier universitaire de Cocody, Abidjan, Côte d'Ivoire
• ⁶Gabriel Toure University Hospital, Bamako, Mali
• ⁷Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
• ⁸Centre National Hospitalier Universitaire, Cotonou, Benin
• ⁹Korle Bu Teaching Hospital, Accra, Ghana

Background: Before the COVID-19 pandemic, the pediatric continuum of HIV care lagged behind that of adults. The present study aimed to describe the effects of the COVID-19 pandemic on access to HIV care among children and adolescents (0-19 years) living with HIV (CALHIV) in five West African countries. Methods: Within this observational multicenter study, we conducted an interrupted time series analysis by including all antiretroviral therapy (ART)-naive CALHIV newly enrolled between 2018 and 2021. Two monthly documented outcomes were analyzed, namely, the number of ART initiators and the number of viral load (VL) tests performed. We fitted Poisson segmented regression models to estimate immediate changes at pandemic onset and per-pandemic trends through incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Results: Immediately after the start of the pandemic, the average number of ART initiations decreased by 83.8% in Burkina Faso (IRR: 0.162; [95%CI: 0.043-0.609]) and 70.9% in Ghana (IRR: 0.291 [0.171-0.494]). Similarly, the number of VL tests performed decreased by 51% in Burkina Faso (IRR: 0.409 [0.253-0.662]). There were no significant trends in the number of ART initiations during the pandemic, except in Ghana (IRR: 1.146 [1.073-1.224]). The number of VL tests performed monthly in clinics in Côte d'Ivoire and Ghana decreased during the pandemic. Conclusion: ART initiation and VL testing activities were maintained in the majority of West African pediatric clinics, despite the COVID-19 pandemic and subsequent crisis. HIV care continuum monitoring in CALHIV should be maintained during the postpandemic period to identify and mitigate potential lasting effects.