Modeling to determine when to re-open HIV services during COVID-19 pandemic

The Risks and Benefits of Providing HIV Services during the COVID-19
Pandemic Introduction The COVID-19 pandemic has caused widespread
disruptions including to health services. In the early response to the
pandemic many countries restricted population movements and some health
services were suspended or limited. In late 2020 and early 2021 some
countries re-imposed restrictions. Health authorities need to balance the
potential harms of additional SARS-CoV-2 transmission due to contacts
associated with health services against the benefits of those services,
including fewer new HIV infections and deaths. This paper examines these
trade-offs for select HIV services.  Methods We used four HIV
simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate
the benefits of continuing HIV services in terms of fewer new HIV
infections and deaths. We used three COVID-19 transmission models
(Covasim, Cooper/Smith and a simple contact model) to estimate the
additional deaths due to SARS-CoV-2 transmission among health workers and
clients. We examined four HIV services: voluntary medical male
circumcision, HIV diagnostic testing, viral load testing and programs to
prevent mother-to-child transmission. We compared COVID-19 deaths in 2020
and 2021 with HIV deaths occurring now and over the next 50 years
discounted to present value. The models were applied to countries with a
range of HIV and COVID-19 epidemics. Results Maintaining these HIV
services could lead to additional COVID-19 deaths of 0.002 to 0.15 per
10,000 clients. HIV-related deaths averted are estimated to be much
larger, 19 - 146 discounted deaths per 10,000 clients. Discussion While
there is some additional short-term risk of SARS-CoV-2 transmission
associated with providing HIV services, the risk of additional COVID-19
deaths is at least 100 times less than the HIV deaths averted by those
services. Ministries of Health need to take into account many factors in
deciding when and how to offer essential health services during the
COVID-19 pandemic. This work shows that the benefits of continuing key HIV
services are far larger than the risks of additional SARS-CoV-2
transmission.