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Head, Molecular Virology Lab
Department of Infectious Diseases
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Head, Infectious Diseases and Epidemiology
Hospital Médica Sur
Mexico City, Mexico
Luis E. Soto-Ramirez, MD, has disclosed that he has received consulting fees from Gilead Sciences, GlaxoSmithKline, Merck, and ViiV Healthcare and fees for non-CME/CE services from Gilead Sciences, Janssen, and Merck.
As of November 24, 2020, there have been 59 million global cases of confirmed COVID-19 and 1.4 million deaths, challenging all healthcare systems worldwide. After more than 10 months of the COVID-19 pandemic, it is clear that no country was prepared for this event, but adverse outcomes have disproportionately affected resource-limited settings. México, with an unprepared healthcare system and a vacillating governmental response, has struggled to contain the pandemic, which has now reached over 1 million cases and 100,000 deaths in the country, and to mitigate the difficult economic consequences.
Challenges to HIV Care
Partially due to nonpharmaceutical interventions and redirecting of resources to fight the COVID-19 pandemic, HIV care has been sidelined. In México, HIV care is provided through individual social insurance for those who have it, but approximately 65% of the patients with HIV lack this insurance. For the latter patients, ARVs and laboratory tests are obtained at federally operated HIV clinics that are often located in the state’s capital city and may require patients to travel for several hours, increasing the potential for exposure to SARS-CoV-2. Fortunately, HIV care in México City is available at many specialized and referral institutions, making it more accessible to the city’s > 20 million inhabitants. When our hospital, a National Institutes of Health facility with an HIV clinic that provides care for approximately 2000 patients, was transformed into a COVID-19–only facility by the federal government, patients with HIV were left without access to direct care.
We immediately gave our patients 2 to 3 months of ART to limit hospital visits. As the pandemic unfolded and going to the hospital became a potential health risk for immunocompromised patients, we saw that a significant number of patients stopped or delayed coming for their ART supply, resulting in involuntary and unexpected treatment interruptions.
Since the first COVID-19 case in México 8 months ago, we have observed that less than 1.5% of patients with HIV in care at our institution developed COVID-19, of whom 1 patient unfortunately died. We were able to use this information about the limited impact of COVID-19 to reassure our patients and to encourage them to continue engaging in care, safely.
To continue to provide HIV care to our patients, our institution was able to implement some creative solutions:
With these responses, we have addressed some of the challenges presented by the COVID-19 pandemic. However, local and countrywide concerns remain as the pandemic continues and the general response of the public regarding protective measures has been very limited. Some of my concerns are:
Now is the time to be creative with new ways to deliver HIV care. Before the pandemic, in response to the high number of patients with HIV who needed care through our clinic, we started a program consisting of annual visits to the outpatient clinic and a hotline for emergencies. We have learned how best to use video calls as a way to deliver routine care and urgent care. With the limited contact that we have had with our patients, we could be missing some of their important concerns, and we must create a program to assess patients’ concerns and outcomes to better address their needs.
The challenges that the SARS-CoV-2/COVID-19 pandemic has created for the continuum of HIV care are evident, especially in many of the HIV clinics in México that were closed or had services limited. We have met these challenges with many creative initiatives to maintain close contact with our patients via phone calls and to provide counselling, psychological support, long-term ART supplies, safe sites for obtaining laboratory blood work, and limited outpatient visits. We believe that our intense, sincere, and transparent effort to help our patients with HIV navigate these difficult times will limit the effects of the pandemic on their health outcomes.
Working together as a world and as a resource-limited country, we should learn from this pandemic and strengthen our health systems, as many other infectious threats will surely occur in the future, limiting the advances in HIV care and affecting long-term goals in this field.
What strategies have you implemented to overcome barriers and retain patients with HIV in care during the COVID-19 pandemic? Please answer the polling question and share your thoughts in the discussion section.
Two Opportunities to Join Us!
Register for an upcoming webinar with me and my colleagues Dra. Leticia Pérez Saleme, Dr. Samuel Navarro, and Dr. Luis Gerardo García Demuner, discussing these strategies and more to overcome challenges imposed on HIV care in México during the COVID-19 pandemic.