Evidence-based interventions for the uptake of HIV treatment services among key populations during COVID-19 lockdown in Sub-Saharan Africa: A systematic review

Abstract

The coronavirus disease 2019 (COVID-19) has had a significant impact on HIV treatment services among key populations (KPs). Little is  known about the interventions implemented to mitigate the impacts of COVID-19 on HIV treatment services among KPs in Sub-Saharan  Africa (SSA). The aim of this systematic review is to assess changes and evidence-based interventions implemented towards  strengthening the uptake of HIV treatment services among KPs during the COVID-19 lockdown in SSA. This review was carried out using  the Preferred Reporting Items for Systematic Reviews and MetaAnalysis guidelines (PRISMA) and registred with the International  Prospective Register of Systematic Reviews (PROSPERO) (CRD42022341813). A comprehensive search of literature was conducted and 17  eligible articles published between 2020-2022 were included. The KPs reported in this systematic review include: female sex workers  (FSW) and their clients, male sex workers (MSW), transgender persons (TG), people who inject drugs (PWID), prisoners and other incarcerated people as well as gay and other men who have sex with men (MSM). The review showed that of the ten studies for HIV  treatment/care service delivery among the general population in SSA during COVID-19 lockdown; five had interventions and the other  five did not have interventions to mitigate the impacts of COVID-19. Regarding KPs, there were limited KP specific interventions (three)  implemented to mitigate the impact of COVID-19 on HIV treatment services. This is attributed to the fact that KPs are generally not  prioritized in the HIV response despite having higher risk of HIV acquisition and transmission. Differentiated service delivery  interventions were implemented among KPs across physical and virtual locations such as drop-in centres; websites; and in communities.  These interventions demonstrated improvements in HIV treatment linkage, initiation, and viral suppression. More evidence-based  interventions are needed to minimize the disruption of the provision and utilization of HIV treatment uptake and delivery among KPs  during pandemic times as they tend to be side-lined, stigmatised, discriminated against, criminalized, violated and denied access to  essential health care services. Such interventions may include the establishment of KP specific health centres and having these considered as part of essential healthcare services to enable continuity of services throughout. There is also a need for increased and  ongoing sensitivity training for health care workers in public health facilities to alleviate stigma and discrimination. Further, the legal  support systems to protect KPs right to health care and policies to minimize discriminatory language/behaviour towards KPs by health  care workers and the public (including strict sanctions) should be in place. Mental health and social supports may also be provided to  improve health and wellbeing of KPs.