TD-17 The impact of COVID-19 on the virological suppression in people living with HIV followed up at the hospital Divina Providência in Luanda, Angola

Abstract

<h3>Background</h3> COVID-19 pandemic caused serious disruptions in health programs worldwide. While some studies showed no decline in viral load suppression rates in ART-treated patients, some others did. Data from African countries revealed constant service disruption but no change in virological suppression rates. The UNAIDS 2022 data for Angola showed a HIV prevalence of 1.5% (1.2–1.7) and a decreasing HIV incidence (0.44 cases per 1000 uninfected population); however, the prevalence of virological suppression in people receiving antiretroviral treatment was not available. <h3>Material and methods</h3> A retrospective study was conducted at the outpatient clinic of Hospital ‘Divina Providência’ (HDP) in Luanda from January 2017 to April 2022. Data from the outpatient clinic database were retrieved using pseudo-anonymity. To investigate the impact of the COVID-19 pandemic on virological control, various analyses were performed. In order to account for the within patient correlation population-averaged panel data regression models were fitted, using generalized estimating equations with binomial family, logit link and within-patient exchangeable correlation structure. Estimates are thus expressed as Odds Ratios (OR) and their corresponding 95% Confidence Intervals (CI). The first trimester of 2017 was utilized as the reference period. <h3>Results</h3> In 6023 patients (table 1) we evaluated 26044 visits. The proportion of patients who were lost to care was much greater among those who had at least one visit in 2019, with 45.8% having no visits in 2020 and having 26.5% no visits in either 2020 nor in 2021. The median time between visits differed across period being higher in period 2 (April 2020-March 2021) [9.9 months (IQR 1.1–16)] and 3 (March 2021-April 2022) [8.5 months (IQR 1.2–17.2)] than in period 1 (2017–2020) [4.9 months (IQR 1.1–9.2) (p&lt;0.001). For the virological efficacy analysis, we included 3505 patients (table 1) who contributed with 7801 visits with measured HIV RNA during the study period. HIV RNA levels were below 50 and 1000 copies/mL in 2644 (75.4%) and 3068 (87.5%) individuals, respectively. Male patients (p &lt;0.001) and those receiving second-line treatments showed lower rates of virological suppression (p &lt;0.001). In a multivariable analysis, care during the third trimester of 2020 is associated with the highest increase in the odds of HIV RNA&gt;1000 copies/mL (OR 1.93, 95%CI 1.06–3.53, p=0.03); the effect is even stronger when HIV RNA&gt;50 copies/mL is analyzed as outcome of interest (OR 2.77, 95%CI 1.52–5.03, p=0.001). <h3>Discussion</h3> COVID-19 was associated with a temporary reduction in HIV virological control in individuals receiving antiretroviral treatment followed at HDP in Luanda. The substantial proportion of patients with HIV RNA &gt;50 copies/mL warrants further studies to better understanding the prevalence of resistance associated mutations and the presence of significant barriers to treatment adherence.