ArticleJournal of clinical epidemiology2022
HIV suppression was maintained during the COVID-19 pandemic in Malawi: a program-level cohort study.
Article in Journal of clinical epidemiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 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
- Repercussions of the COVID-19 pandemic on the HIV care continuum and related factors in economically disadvantaged nations: an integrated analysis using mixed-methods systematic review.European journal of medical research · 2024Pooled it
- Estimates and predictors of HIV viral non-suppression in South African adults on antiretroviral treatment.Journal of the International AIDS Society · 2026Article
- Evaluating the impact of the COVID-19 pandemic on viral load and CD4 monitoring for people living with HIV on ART in rural Lesotho.BMC infectious diseases · 2025Article
- Association between changes in script renewal periods and HIV viral non-suppression: a cohort study of a South African private-sector HIV program.Journal of acquired immune deficiency syndromes (1999) · 2025Article
- Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study.BMC infectious diseases · 2025Article
- Viral Load Suppression in People Living with HIV Before and During the COVID-19 Pandemic in Brooklyn, New York.AIDS and behavior · 2024Article
- Early Effects of Scaling Up Dolutegravir-Based ARV Regimens Among Children Living with HIV in Malawi.AIDS and behavior · 2024Article
- Effects of the COVID-19 pandemic on HIV service delivery and viral suppression: Findings from the SHARP program in Northern Nigeria.PloS one · 2024Article
- The impact of the COVID-19 pandemic on HIV healthcare delivery for females in sub-Saharan Africa: A scoping review.PLOS global public health · 2024Article
- Effectiveness of online HIV treatment services in the context of the COVID-19 pandemic.Health care science · 2023Article
- Effect of Multi-Month Dispensing on Viral Suppression for Newly Enrolled Adolescents and Adults in Northern Nigeria.HIV/AIDS (Auckland, N.Z.) · 2023Article
- Service Interruption in HIV Care Amid COVID-19 Pandemic in Myanmar: Results From Analysis of Routine Program Data 2018-2022.Journal of the International Association of Providers of AIDS CareArticle
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6 authors at 2 institutions in 4 countries.
Funding
Abstract
BACKGROUND AND
objectivesMeasures introduced to reduce the spread of SARS-CoV-2 by the Malawi government and the national HIV care program might have compromised treatment outcomes of patients living with HIV on antiretroviral therapy (ART). We studied viral load (VL) outcomes before and during the COVID-19 epidemic in Malawi.
methodsIn this population-based cohort study, we included all routine VL measurements collected from July 2019 to December 2020 in about 650 ART clinics in Malawi. We examined differences between pandemic periods (before/during COVID-19) for i) VL monitoring, and ii) VL suppression (VLS: <1,000 copies/ml). For i) we studied the number of VL measurements over time and assessed predictors of missed measurements before and during COVID-19 in logistic regression models. For ii) we estimated the odds of VLS before and during the COVID-19 epidemic stratified by treatment regimen using generalized estimation equations adjusted for age, sex, time on ART, and type of biological sample. We imputed missing treatment regimens by population-calibrated multiple imputation.
resultsWe included 607,894 routine VL samples from 556,281 patients. VL testing declined during COVID-19 (243,729; 40%) compared to before COVID-19 (365,265; 60%), but predictors of missing tests were similar in the two periods. VLS rates increased slightly from 93% before to 94% during COVID-19. Compared to before COVID-19, the odds of VLS increased during COVID-19 for patients on protease inhibitor-based (PI) regimens (adjusted odds ratio [aOR] 1.22, 95% CI: 0.99-1.49) and for patients on integrase strand transfer inhibitor-based (INSTI) regimens (aOR 1.10, 95% CI: 1.03-1.17). There was no difference in VLS between the two periods among patients on nonnucleoside reverse transcriptase inhibitor-based (NNRTI) regimens. VLS varied by age, sex, regimen, and duration on ART, ranging from 45.1% (95% CI 40.3-50.0%) to 97.2% (95% CI 96.9-97.4%).
conclusionThere was a significant decline in VL monitoring during COVID-19, but we did not find clear evidence that the pandemic reduced VL suppression rates. Routine scheduled VL monitoring, targeted adherence support, and timely regimen switches for patients with treatment failure remain critical to improving VLS.
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