From testing to treatment, the Global Fund’s HIV services have been hampered by COVID-19. “We have been slowed down by COVID but we have seen remarkable resilience, a lot of innovation and creativity,” said Siobhan Crowley MD, head of HIV at the Global Fund. Medscape Medical News.

Dr Siobhan Crowley

“If you consider that 21.9 million people are receiving antiretrovirals at this stage through the Global Fund, I think that must be appreciated. Ten years ago, that would not have been the case; all of these people would have disappeared in the ethers, “she said.

Through close partnerships with the United States Agency for International Development, the President’s Emergency Plan for AIDS Relief, and other Western countries and organizations, the Global Fund has invested $ 22.7 billion in HIV and AIDS prevention and treatment programs, and $ 3.8 billion in tuberculosis (TB programs) / HIV, according to the organization’s 2021 results report.

But the report also highlights the significant effect the COVID-19 pandemic has had on the progress of funded countries towards meeting the renewed 90-90-90 targets for HIV testing / diagnosis, treatment and viral suppression. ‘by 2030.

The setbacks have been difficult and have affected almost every service, from prevention to treatment. According to the report, between 2019 and 2020:

  • Voluntary male circumcision decreased by 27%

  • The number of people reached by HIV prevention programs has fallen by 11%

  • 4.5% fewer mothers received drugs to prevent transmission of HIV to their babies

  • HIV testing services, including initiation, decreased by 22%

The numbers only tell part of the story, according to Crowley.

“We have put in place an emergency mechanism to make funds available to countries to do everything except vaccines in support of COVID,” Crowley explained. (As of August 2021, these funds had been allocated to 107 countries and 16 multi-country programs.)

Countries were told they could use emergency funds in three different ways: 1) for specific COVID purposes (e.g. diagnostics, oxygen, personal protective equipment; 2) to support mitigation strategies to protect existing HIV, TB and malaria programs and get them back on track; and 3) for so-called “health system fixes,” such as investing in data systems to track COVID, HIV and other fundamental diseases, as well as the community workforce.

With regard to HIV in particular, each country supported by the Global Fund has been asked to ensure that multi-month (3-6 months) distribution is implemented and / or accelerated so that patients can avoid overcrowded facilities and, where possible, that drugs are delivered. or accessible outside the establishment. An example of the success of this effort was found in South Africa, where the number of people on antiretrovirals nearly tripled from 1.2 million to 4.2 million people.

Countries were also urged to adapt HIV testing procedures, for example by moving organized testing out of facilities and into neighborhoods to meet people where they are. Rapid diagnostic testing and a triage care link using technologies like WhatsApp have been the result, as have home testing opportunities which, Crowley noted, remain a critical part of the overall strategy.

“Self-testing is important for two reasons, not only because you are trying to find people who are HIV positive, but also when people know they are negative they know what they can or should do to stay negative,” she declared. . “It’s a pretty powerful motivator.”

The self-test could also help countries motivate the 6 million people who know they are HIV-positive but are not on treatment. But there are still 4.1 million residents in those countries who are unaware they are infected, according to the report. This figure is particularly troubling, given that some may also harbor tuberculosis co-infections, including multidrug-resistant tuberculosis (MDR-TB).

The imperfect storm in the world and in the United States

Dr Chris Beyrer

“One of the things that is striking about the report is the decline in the number of people reached by screening and prevention services,” Chris Beyrer, MD, MPH, Desmond M. Tutu professor of public health and human rights male at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, said Medscape Medical News. Beyrer was not involved in the preparation of the report.

“You know, a 10% drop in one year to reach people in need is substantial,” he said. “Let’s say this continues; many people predict that we will not have reasonable coverage for low-income countries with COVID until 2023. This adds to a substantial drop in the number of people reached with these services. “

Beyrer also expressed concern about the convergence of HIV and TB in already overburdened and fragile health systems. “Globally, the leading cause of death for people living with HIV is tuberculosis, and of course, it is highly transmissible. So in many high burden countries children are exposed, usually by household members early on, and so the number of people with latent TB infection is simply huge. “

“If you look at the report, the worst results are MDR-TB. These multidrug-resistant and extensively drug-resistant strains are really a threat to everyone,” Beyrer said.

But now is not the time for US suppliers to rest on their laurels. Beyrer noted that the 22% drop in HIV testing reported by the Global Fund is similar to what’s happening in the United States with elective procedures like HIV testing and even preventive procedures like medical male circumcision.

“It is very clear here in the Global Fund data that the majority of new infections worldwide are in key populations. [that] include gay and bisexual men, men who have sex with men, transgender women who have sex with men, people who inject drugs, sex workers of all genders. These are people who have already faced barriers to accessing health care and who have been made worse by COVID. “

Beyrer noted that, according to the Centers for Disease Control and Prevention, in 2019 in the United States, 68% of new HIV infections occurred in gay and bisexual men, and the effect COVID will have is still unknown. He also noted the similarity between the most marginalized populations in the Global Fund report and African American men, who did not achieve the same increase in pre-exposure prophylaxis use or the same decline in new infections as they did. their white counterparts.

“This is also where we see the worst of COVID, low immunization coverage and high rates of hospitalization and death.… It’s a dark and gloomy time for many,” Crowley said. “And there was incredible resilience and adaptation as well. What is strange is that the HIV platform is a natural platform; I mean, if we can keep 21.9 million people on treatment, we can probably provide them with a COVID test and a vaccine. “

Crowley and Beyrer do not report any relevant financial relationship.

Liz Scherer is a freelance journalist specializing in infectious and emerging diseases, cannabinoid therapeutics, neurology, oncology and women’s health.

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