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Effect of COVID-19 on HIV, tuberculosis, and prevention of mother-to-child transmission of HIV indicators in Mopani district, South Africa

C Mutyambizi, J Dunlop, C Maluleke, L Ranoto, T Chetty, R Ndou, H Struthers, J A McIntyre, K Rees

Abstract


Background. To prevent the spread of SARS-CoV-2, many countries instituted lockdown measures. As the virus was initially slow to spread to rural areas in South Africa, Mopani district in Limpopo Province did not experience a high incidence of COVID-19 until the second wave in December 2020. Until then, lockdown measures were more likely than SARS-CoV-2 infections to have an adverse impact on health services.

Objectives. To analyse HIV, tuberculosis (TB) and prevention of mother-to-child transmission of HIV (PMTCT) indicator trends in Mopani during the COVID-19 lockdown and two COVID-19 waves.

Methods. Using monthly data from the District Health Information System from February 2019 to December 2020, we conducted a retrospective review of data elements and indicators that fall into the following domains: primary healthcare head count (HC), HIV, antiretroviral treatment (ART), PMTCT and TB. Aggregated data were analysed, and an interrupted time series analysis was conducted. We assessed percentage changes between the January - March 2020 and April - June 2020 periods, and differences in means for the period April - December 2019 v. the period April - December 2020 were assessed for statistical significance.

Results. At the start of the first wave in April 2020, a statistically significant decline of 10% was recorded for total HC utilisation rates (p=0.1). We also found declines of 665 HIV tests (from 1 608 to 942) and 22 positive HIV tests (from 27 to 4) for children between the ages of 18 months and 14 years (p=0.05), with no recovery. Significant declines were also recorded for children aged <15 years starting (change from 35 to 21) and remaining (change from 4 032 to 3 986) on ART, as well as for adults starting ART (change from 855 to 610) at the onset of the first wave (p=0.01). No significant change was detected in PMTCT and TB indicators during the first wave. Pronounced decreases in HC were recorded in December, during the country’s second wave (change from 237 965 to 227 834).

Conclusion. Declines were recorded for most indicators in Mopani, with HC being affected the most at the start of the first wave and not showing any significant recovery between waves. Strategies are required to mitigate the effects of future COVID-19 waves and encourage positive health-seeking behaviour.


Authors' affiliations

C Mutyambizi, Anova Health Institute, Johannesburg, South Africa

J Dunlop, Anova Health Institute, Johannesburg, South Africa; Division of Community Paediatrics, School of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

C Maluleke, Division of Community Paediatrics, School of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

L Ranoto, Anova Health Institute, Johannesburg, South Africa

T Chetty, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa

R Ndou, Anova Health Institute, Johannesburg, South Africa

H Struthers, Anova Health Institute, Johannesburg, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

J A McIntyre, Anova Health Institute, Johannesburg, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

K Rees, Anova Health Institute, Johannesburg, South Africa; Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

COVID-19; Lockdown; Mopani district; South Africa; Interrupted time series analysis; Health utilisation

Cite this article

South African Medical Journal 2021;111(12):1181-1189. DOI:10.7196/SAMJ.2021.v111i12.15822

Article History

Date submitted: 2021-12-02
Date published: 2021-12-02

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