Viral load measurements and viral suppression in a cohort of acutely treated people living with HIV during the COVID-19 pandemic in Bangkok, Thailand: a longitudinal cohort analysis

Introduction: Lockdowns during the COVID-19 pandemic decreased disease transmission by reducing social interactions but also potentially hindered access to medical care. For individuals who face social and structural barriers to healthcare, such as people with HIV, the overall effect on medical care is unclear. Methods: Using data from the RV254/SEARCH010 study, a cohort of people with acutely treated HIV, we examined changes in HIV care during the COVID-19 pandemic. Participants with at least one suppressed viral load measurement (≤1000 copies/mL) after 24 weeks on antiretroviral therapy (ART) between 1 January 2018 and 30 September 2023 were included to assess maintenance of HIV care. Time periods were defined as pre-COVID-19, COVID-19 and post-lockdown. COVID-19 was further divided into lockdown 1 (16 March to 3 May 2020), lockdown 2 (1 May to 6 June 2021) and the open inter-lockdown period. Generalised estimating equations were used to calculate prevalence ratios (PRs) of measurements/year and ORs of viral suppression, with 95% CIs. Analyses were adjusted for demographic factors, ART regimen and enrolment status (newly enrolled or established in care). Results: Among 606 participants, 591 (97.5%) were male with a median age of 26.9 years. Participants had 3.50 measurements/year in the pre-COVID-19 period, which decreased to 2.36/year (aPR 0.67 (95% CI 0.65 to 0.70)) during the COVID-19 period and 2.56/year (aPR 0.73 (0.71-0.75)) in the post-lockdown period. Older participants also had fewer measurements/year compared with those 18-19 years of age (20-29 years, aPR 0.90 (0.82-0.98); ≥30 years, aPR 0.88 (0.80-0.97)), as did sex workers (aPR 0.91 (0.85-0.96)). Viral suppression remained unchanged during the COVID-19 (aOR 0.95 (0.43-2.07)) and post-lockdown (aOR 0.95 (0.48-1.88)) periods compared with pre-COVID-19. During the COVID-19 period, there were fewer measurements in lockdowns 1 and 2 (0.34/year and 0.14/year) than the inter-lockdown period (2.82/year). Conclusions: Lockdowns during COVID-19 reduced HIV care engagement, particularly among participants established in care, without affecting viral suppression.