ArticleBMC health services research2022
Reduction in initiations of HIV treatment in South Africa during the COVID pandemic.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Evaluating the impact of COVID-19 on the HIV care continuum across global income levels: a mixed-methods systematic review.AIDS research and therapy · 2025Pooled it
- Pooled it
- The Social, Behavioral, and Ethical Modalities of COVID-19 on HIV Care in South Africa: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Impact of COVID-19-Related Disruptions on Antiretroviral Therapy Adherence Among Young Adults Living with HIV in Southern Uganda.AIDS and behavior · 2025Trial
- Tuberculosis (TB) service utilisation pre and peri-COVID-19 restrictions in Johannesburg, Gauteng.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2026Article
- Trends and Disruptions in Antiretroviral Treatment Enrollment in Haiti, 2018-2024.The American journal of tropical medicine and hygiene · 2026Article
- Article
- Factors influencing treatment default among patients initiated on antiretroviral at a district in the North West province of South Africa: A qualitative study.Health SA = SA Gesondheid · 2026Article
- Estimates and predictors of HIV viral non-suppression in South African adults on antiretroviral treatment.Journal of the International AIDS Society · 2026Article
- Do men face greater barriers to accessing HIV testing services than women? Might HIV self-testing be the answer? Evidence from a longitudinal survey in east Zimbabwe (2018-2023).PLOS global public health · 2026Article
- Evaluation of economic strengthening in South Africa and its impact on HIV, sexually transmitted infections, and teenage births: A modelling study.PLoS medicine · 2025Article
- The Ripple Effect of COVID-19: How Lockdown Regulations Shaped Antiretroviral Therapy Initiation Among People Living With HIV in Johannesburg.Nursing & health sciences · 2025Article
- One year on - the long-term impact of COVID-19 pandemic and government restrictions on the health-seeking behaviour, financial security and mental health of TB survivors.BMC public health · 2025Observational
- Challenges Faced by Perinatally-Infected Kenyan Adolescents and Youth Living with HIV During the COVID-19 Pandemic.AIDS and behavior · 2025Article
- The impact of COVID-19 pandemic on mortality among adults receiving care for chronic health conditions in rural South Africa: findings from Agincourt health and socio-demographic surveillance system.Population health metrics · 2025Article
- Social Support as a Mediator in the Relationship Between Stigma and Mental Health in Adults Living with HIV.International journal of environmental research and public health · 2025Article
- Potential Clinical and Economic Impacts of Cutbacks in the President's Emergency Plan for AIDS Relief Program in South Africa : A Modeling Analysis.Annals of internal medicine · 2025Article
- Impact of COVID-19 on the HIV Treatment Outcomes Among Men Who Have Sex with Men in South Africa After the Implementation of a Differentiated Service Delivery Model: An Interrupted Time Series Analysis.International journal of environmental research and public health · 2025Article
- Barriers and facilitators of HIV treatment services among men who have sex with men during COVID-19 lockdown.Southern African journal of HIV medicine · 2025Article
- Viral load dynamics among adults receiving HIV care in rural North-Eastern South Africa, 2015-2020: insights from a population-based record linkage study.Frontiers in public health · 2025Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundIn response to the global pandemic of COVID-19, countries around the world began imposing stay-at-home orders, restrictions on transport, and closures of businesses in early 2020. South Africa implemented a strict lockdown in March 2020 before its first COVID-19 wave started, gradually lifted restrictions between May and September 2020, and then re-imposed restrictions in December 2020 in response to its second wave. There is concern that COVID-19-related morbidity and mortality, fear of transmission, and government responses may have led to a reduction in antiretroviral treatment (ART) initiations for HIV-infected individuals in countries like South Africa.
methodsWe analyzed national, public sector, facility-level data from South Africa's District Health Information System (DHIS) from January 2019 to March 2021 to quantify changes in ART initiation rates stratified by province, setting, facility size and type and compared the timing of these changes to COVID-19 case numbers and government lockdown levels. We excluded facilities with missing data, mobile clinics, and correctional facilities. We estimated the total number of ART initiations per study month for each stratum and compared monthly totals, by year.
resultsAt the 2471 facilities in the final data set (59% of all ART sites in the DHIS), 28% fewer initiations occurred in 2020 than in 2019. Numbers of ART initiations declined sharply in all provinces in April-June 2020, compared to the same months in 2019, and remained low for the rest of 2020, with some recovery between COVID-19 waves in October 2020 and possible improvement beginning in March 2021. Percentage reductions were largest in district hospitals, larger facilities, and urban areas. After the initial decline in April-June 2020, most provinces experienced a clear inverse relationship between COVID-19 cases and ART initiations but little relationship between ART initiations and lockdown level.
conclusionsThe COVID-19 pandemic and responses to it resulted in substantial declines in the number of HIV-infected individuals starting treatment in South Africa, with no recovery of numbers during 2020. These delays may lead to worse treatment outcomes for those with HIV and potentially higher HIV transmission. Exceptional effort will be needed to sustain gains in combatting HIV.
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