The COVID-19 pandemic will make it more difficult to achieve global targets to eliminate HIV transmission in Asia and the Pacific, but the response has also led to some surprising innovation, according to the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM).
Drawing on experience supporting HIV services throughout the region, ASHM met with experts from countries including Papua New Guinea and Indonesia at the Australasian HIV & AIDS and Sexual Health Conferences to discuss the impact of COVID-19 on HIV for Australia's neighbours.
With estimates from the Global Fund to Fight AIDS, Tuberculosis and Malaria of disruptions in up to 85% of HIV services in over 100 countries, the impact of COVID-19 will be experienced across the region's HIV response, with less people able to access services for prevention, testing, treatment and support, ASHM has said. This will create short and long-term challenges particularly for people living with HIV, who may face disruptions to treatment that can lead to treatment resistance and increased HIV transmission.
But while COVID-19 has placed considerable strain on already fragile health systems in some countries in the region, the discussion highlighted some of the ways the pandemic has prompted new investments in health, and in some cases, innovation.
In Papua New Guinea, where ASHM runs programs supporting HIV health workers, the COVID-19 pandemic has forced HIV services to adapt to provide treatment and support for people living with HIV, closer to their community.
For example, some clinics are now dispensing multiple months of HIV medications at once, meaning that people living with HIV have fewer clinic visits, reducing possible exposure to COVID-19. Other clinics have been able to deliver medications directly to people at home, and some have trialled mobile phone screening and support for patients.
The use of technology prompted by COVID-19 has enabled ongoing training for health workers via online education, and increased use of mobile and social media has also allowed greater reach when sending evidence-based information on COVID-19 during the response.
Meeting virtually on Tuesday at the conference, HIV experts from across the region discussed the impact of COVID-19 on the UNAIDS '95-95-95' targets. These targets are a key measure for the UNAIDS global goal of ending the AIDS epidemic by 2030, and aim to have 95% of people living with HIV diagnosed, 95% of people who are diagnosed on treatment, and 95% per cent of people on treatment with a suppressed viral load.
This work follows the establishment in March of ASHM's Regional Advisory Group on Blood-Borne Viruses, Sexual Health and COVID-19. Throughout the year, the Regional Advisory Group has provided clinical guidance to healthcare workers throughout Asia and the Pacific, sharing up-to-date information about the impact of COVID-19 on the region's HIV and sexual health responses.
As noted by Alexis Apostolellis, ASHM CEO
"COVID-19 has already had, and will continue to have, significant impacts on the capacity of HIV, viral hepatitis and sexual health services to deliver care to those in the Asia-Pacific region who need it most."
"The pandemic is affecting supply chains, the function of healthcare systems and the ability of people to access the health services that they need—these are significant challenges for achieving global and regional targets for HIV."
As noted by Nikki Teggelove, ASHM International Program Adviser
"Access to HIV services, including prevention, testing and treatment, has been hindered by COVID-19, creating further vulnerability as people are unable to access the services they need"
"Through ASHM's work in Papua New Guinea we've seen COVID-19 prompt innovations to reduce clinic visits, and hence potential COVID-19 exposure for people living with HIV. This has included multi-month dispensing of medication, community or home delivery and increased telehealth and online treatment support"
"Despite the challenges, COVID-19 presents opportunities within the region to create more accessible testing, treatment and adherence support, especially in countries with lower achievements against the UNAIDS 95-95-95 targets."
