The impact of COVID-19 pandemic on access to HIV services at urban context-based health facilities supported by CUAMM in collaboration with UNICEF, in Beira Mozambique

Introduction: Since 2014, Doctors with Africa – CUAMM, is implementing in Beira, Mozambique health projects focused on: healthcare workers training, data collecting, health commodities supply and technical support to SAAJs (Serviço Amigo do Adolescente e Jovem), a network of primary health care centers promoting prevention and providing diagnosis, treatment, and retention in care of HIV patients. Starting from March 2020, the global spread of COVID-19 has been severely affecting public-health systems and economies worldwide. We describe the impact that COVID-19 had on the public-health projects supporting SAAJs in Beira, Mozambique. Methods: Multi-center, retrospective observational study including HIV patients aged 10-24 years old attending SAAJs in Beira. Enrolled and lost to follow-up (LTFU) patients per month and HIV-viral load were considered indicators of CUAMM’s implementing strategies. Four pandemic waves affecting Mozambique were identified: a first wave from September to November, 2020, second wave from January to March, 2021, third wave from June to September, 2021 and a fourth current wave started in December, 2021. Data were described with numbers and percentages. Mann-Kendall test was used to assess the monthly trend, and a linear regression model was applied. Results: Data of eight SAAJs were analyzed from June 2019 to December 2021. The longitudinal evaluation of enrolled and follow-up subjects showed a significant increasing trend, with 35 new subjects per month treated with antiretroviral (ARV) in all SAAJs. The overall monthly number of patients on ARV therapy in December 2021 was five-fold higher than in June 2019 (1603 vs 328), with no decline or arrest after each wave (Fig.1). Moreover, the number of LTFU patients showed a decline of 3‰ each month across the analyzed period (Fig.2). To support these findings, has been found a coherent viral suppression achieved in most HIV-treated patients from March, 2021 to December, 2021. Conclusions: All government health-centers involved and supported by CUAMM projects, treating youths living with HIV in Beira, presented with a higher number of treated patients at every time point of the follow-up. The ongoing pandemic seems not to have impacted health systemms implementation programs in this country. Other studies are needed to support this encouraging hypothesis.