The risks and benefits of providing HIV services during the COVID-19 pandemic.
<h4>Introduction</h4>The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries r...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0260820 |
| _version_ | 1830176447891767296 |
|---|---|
| author | John Stover Sherrie L Kelly Edinah Mudimu Dylan Green Tyler Smith Isaac Taramusi Loveleen Bansi-Matharu Rowan Martin-Hughes Andrew N Phillips Anna Bershteyn |
| author_facet | John Stover Sherrie L Kelly Edinah Mudimu Dylan Green Tyler Smith Isaac Taramusi Loveleen Bansi-Matharu Rowan Martin-Hughes Andrew N Phillips Anna Bershteyn |
| author_sort | John Stover |
| collection | DOAJ |
| description | <h4>Introduction</h4>The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services.<h4>Methods</h4>We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics.<h4>Results</h4>Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19-146 discounted deaths per 10,000 clients.<h4>Discussion</h4>While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission. |
| first_indexed | 2024-12-17T19:07:05Z |
| format | Article |
| id | doaj.art-47ecafebb8af45bcbdeb617a7274fff8 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-17T19:07:05Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-47ecafebb8af45bcbdeb617a7274fff82022-12-21T21:35:58ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-011612e026082010.1371/journal.pone.0260820The risks and benefits of providing HIV services during the COVID-19 pandemic.John StoverSherrie L KellyEdinah MudimuDylan GreenTyler SmithIsaac TaramusiLoveleen Bansi-MatharuRowan Martin-HughesAndrew N PhillipsAnna Bershteyn<h4>Introduction</h4>The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services.<h4>Methods</h4>We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics.<h4>Results</h4>Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19-146 discounted deaths per 10,000 clients.<h4>Discussion</h4>While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.https://doi.org/10.1371/journal.pone.0260820 |
| spellingShingle | John Stover Sherrie L Kelly Edinah Mudimu Dylan Green Tyler Smith Isaac Taramusi Loveleen Bansi-Matharu Rowan Martin-Hughes Andrew N Phillips Anna Bershteyn The risks and benefits of providing HIV services during the COVID-19 pandemic. PLoS ONE |
| title | The risks and benefits of providing HIV services during the COVID-19 pandemic. |
| title_full | The risks and benefits of providing HIV services during the COVID-19 pandemic. |
| title_fullStr | The risks and benefits of providing HIV services during the COVID-19 pandemic. |
| title_full_unstemmed | The risks and benefits of providing HIV services during the COVID-19 pandemic. |
| title_short | The risks and benefits of providing HIV services during the COVID-19 pandemic. |
| title_sort | risks and benefits of providing hiv services during the covid 19 pandemic |
| url | https://doi.org/10.1371/journal.pone.0260820 |
| work_keys_str_mv | AT johnstover therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT sherrielkelly therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT edinahmudimu therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT dylangreen therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT tylersmith therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT isaactaramusi therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT loveleenbansimatharu therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT rowanmartinhughes therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT andrewnphillips therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT annabershteyn therisksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT johnstover risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT sherrielkelly risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT edinahmudimu risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT dylangreen risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT tylersmith risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT isaactaramusi risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT loveleenbansimatharu risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT rowanmartinhughes risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT andrewnphillips risksandbenefitsofprovidinghivservicesduringthecovid19pandemic AT annabershteyn risksandbenefitsofprovidinghivservicesduringthecovid19pandemic |