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      Impact of the COVID-19 Pandemic on HIV Services in Korea: Results from a Cross-Sectional Online Survey

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          Abstract

          Background

          Globally, the coronavirus disease 2019 (COVID-19) pandemic has compromised human immunodeficiency virus (HIV) services. The study aimed to assess the impact of COVID-19 on the access and delivery of HIV care in Korea.

          Materials and Methods

          People living with HIV (PLHIV), people at risk of HIV (PAR) and prescribers of HIV care were recruited through a patient advocacy group, online communities for men who have sex with men (MSM) and a HIV care center for a web-based survey between October 22 and November 26, 2020. The survey compared the frequency of hospital/clinic visits, HIV-related testing, access to antiretroviral therapy (ART) or preventive medications, and experience with telehealth services by PLHIV and PAR between the pre-pandemic and pandemic eras.

          Results

          One hundred and twelve PLHIV (mean age: 38.5 ± 10.2 years), 174 PAR (mean age: 33.5 ± 8.0 years) and 9 prescribers participated the survey; ≥97% of the PLHIV and PAR were male. A greater proportion of PAR than PLHIV reported a decrease in the frequency of hospital/clinical visits (59.2% vs. 17.0%) and HIV-related testing (50.6% vs. 6.3%) since COVID-19. Among PAR, not engaging or engaging less in high-risk behaviors was the most frequently cited reason (51.1%) for decreased frequency of HIV-related tests. A substantial proportion of PLHIV (12.5%) and PAR (50.0%) experienced interrupted use of ART and HIV preventive medications, respectively. A substantial proportion of PLHIV (35.7%) and PAR (62.5%) were concerned about the long-term accessibility of HIV care, however, >90% had not used any types of telehealth services during the pandemic.

          Conclusion

          Overall, COVID-19 has negatively impacted the access and delivery of HIV services in Korea, especially HIV-related testing for PAR. Our findings highlight the need to develop strategies to mitigate the interrupted HIV care.

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          Most cited references15

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          Fair Allocation of Scarce Medical Resources in the Time of Covid-19

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            Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study

            Summary Background COVID-19 has the potential to cause substantial disruptions to health services, due to cases overburdening the health system or response measures limiting usual programmatic activities. We aimed to quantify the extent to which disruptions to services for HIV, tuberculosis, and malaria in low-income and middle-income countries with high burdens of these diseases could lead to additional loss of life over the next 5 years. Methods Assuming a basic reproduction number of 3·0, we constructed four scenarios for possible responses to the COVID-19 pandemic: no action, mitigation for 6 months, suppression for 2 months, or suppression for 1 year. We used established transmission models of HIV, tuberculosis, and malaria to estimate the additional impact on health that could be caused in selected settings, either due to COVID-19 interventions limiting activities, or due to the high demand on the health system due to the COVID-19 pandemic. Findings In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36%, respectively, compared with if there was no COVID-19 pandemic. The greatest impact on HIV was estimated to be from interruption to antiretroviral therapy, which could occur during a period of high health system demand. For tuberculosis, the greatest impact would be from reductions in timely diagnosis and treatment of new cases, which could result from any prolonged period of COVID-19 suppression interventions. The greatest impact on malaria burden could be as a result of interruption of planned net campaigns. These disruptions could lead to a loss of life-years over 5 years that is of the same order of magnitude as the direct impact from COVID-19 in places with a high burden of malaria and large HIV and tuberculosis epidemics. Interpretation Maintaining the most critical prevention activities and health-care services for HIV, tuberculosis, and malaria could substantially reduce the overall impact of the COVID-19 pandemic. Funding Bill & Melinda Gates Foundation, Wellcome Trust, UK Department for International Development, and Medical Research Council.
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              Characterizing the Impact of COVID-19 on Men Who Have Sex with Men Across the United States in April, 2020

              The COVID-19 pandemic is reinforcing health inequities among vulnerable populations, including men who have sex with men (MSM). We conducted a rapid online survey (April 2 to April 13, 2020) of COVID-19 related impacts on the sexual health of 1051 US MSM. Many participants had adverse impacts to general wellbeing, social interactions, money, food, drug use and alcohol consumption. Half had fewer sex partners and most had no change in condom access or use. Some reported challenges in accessing HIV testing, prevention and treatment services. Compared to older MSM, those 15–24 years were more likely to report economic and service impacts. While additional studies of COVID-19 epidemiology among MSM are needed, there is already evidence of emerging interruptions to HIV-related services. Scalable remote solutions such as telehealth and mailed testing and prevention supplies may be urgently needed to avert increased HIV incidence among MSM during the COVID-19 pandemic era. Electronic supplementary material The online version of this article (10.1007/s10461-020-02894-2) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Infect Chemother
                Infect Chemother
                IC
                Infection & Chemotherapy
                The Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy; The Korean Society for AIDS
                2093-2340
                2092-6448
                December 2021
                20 December 2021
                : 53
                : 4
                : 741-752
                Affiliations
                [1 ]Gilead Sciences Korea Ltd, Seoul, Korea.
                [2 ]Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Jun Yong Choi, MD. Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-1974, Fax: +82-2-393-6884, seran@ 123456yuhs.ac
                Author information
                https://orcid.org/0000-0001-7953-2357
                https://orcid.org/0000-0002-0477-4367
                https://orcid.org/0000-0002-2775-3315
                Article
                10.3947/ic.2021.0112
                8731254
                34979605
                f9ca9fec-2e23-4386-9a0e-fc51bf4bb7ff
                Copyright © 2021 by The Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, and The Korean Society for AIDS

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 October 2021
                : 13 December 2021
                Funding
                Funded by: Gilead Sciences, CrossRef https://doi.org/10.13039/100005564;
                Categories
                Original Article

                covid-19,sars-cov-2,hiv infections,pre-exposure prophylaxis,anti-retroviral agents

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