Intersecting Epidemics: The implications of COVID-19 in the utilisation of HIV treatment services among people living with HIV on antiretroviral treatment (ART) in Zimbabwe

Abstract

Zimbabwe has been working towards the last mile of controlling the Human Immunodeficiency Virus (HIV) epidemic where keeping people that are living with HIV on antiretroviral therapy (ART) is primarily important. Ensuring they are virally suppressed and can thwart opportunistic infections is key. The advent of COVID-19 potentially posed a threat of derailing or reversing the gains attained in the fight against HIV. Zimbabwe has more than one million people living with HIV (United Nations Programme on HIV and AIDS [UNAIDS], 2020). The question of whether the COVID-19 pandemic intensified barriers and redefined the utilisation of HIV treatment services by people who are living with HIV on ART in Zimbabwe has remained largely unanswered in the literature currently available. Thus, the main purpose of this research was to examine the implications of COVID-19 in the utilisation of HIV care treatment services among people who are living with HIV on ART in Zimbabwe and the factors associated with it. This study defined, the utilisation of HIV treatment services as accessing and taking up a package of services expected to be received by people who are living with HIV on ART such as scheduled ART drug refill collections, viral load monitoring, Tuberculosis (TB) preventative therapy and TB screening. In addition, the study investigated the predisposition of people who are living with HIV in using the COVID-19 vaccine and the reasons behind not getting vaccinated. The study was anchored in the fifth revision of the Andersen behavioural model of healthcare utilisation. This model argues that the use of health services is a based on of three factors classified as (1) predisposing, (2) enabling and (3) need factors. The fifth model version of the model allowed the addition of environmental factors. The dependent variable was the utilisation of HIV treatment services and also COVID-19 vaccination among people living with HIV. As such, it was critical to anchor the study in this framework as it sought to identify the critical factors of utilisation of HIV treatment services and COVID-19 vaccination among people living with HIV. Therefore, following the Anderson model, the predisposing factors for this study were age, sex, marriage, religion, education and COVID-19 vaccination. The enabling factors were COVID-19 lockdown restrictions, COVID- 19 transport stoppages, distance to a health facility, transport cost to a health facility, fear of contracting COVID-19, non-availability of community healthcare services, and COVID-19 related stigma among healthcare workers. The need factors were opportunistic infection during the COVID- 19 period, COVID-19 infection, and contact with a COVID-19 case, while environmental factors were residence and type of health facility.