Abstract

Impact of COVID-19-related clinic closures on HIV incidence in a multicentre study of young adult MSM and transgender women in Kenya

Wahome E, Otieno FO, Kimani J, Boyd A, Okall D, Nzioka J, Gichuru E, van der Elst E, Mehta SD, Bailey RC, Graham SM, Sanders EJ
Aids. 2024;38

Permenent descriptor

INTRODUCTION: Little is known about the impact that the COVID-19 pandemic had on risk of HIV acquisition in sub-Saharan Africa. We assessed the impact of COVID-19-related clinic closures on HIV incidence in a cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women (TW) in Kenya. METHODS: MSM and TW enrolled in a prospective, multicenter cohort study were followed quarterly for HIV testing, behavior assessments, and risk. We estimated the HIV incidence rate (IR) and its 95% credible intervals (CrI) among participants who were HIV-negative before COVID-19-related clinic closure, comparing IR and risk factors associated with HIV acquisition before vs. after clinic reopening, using a Bayesian Poisson model with weakly-informative priors. RESULTS: A total of 690 (87%) participants returned for follow-up after clinic reopening [total person-years (PY) 664.3 during clinic closure and 1013.3 after clinic reopening]. HIV IR declined from 2.05/100PY (95%CrI = 1.22-3.26, n = 14) during clinic closures to 0.96/100PY (95%CrI = 0.41-2.07, n = 10) after clinic reopening (IRR = 0.47, 95%CrI = 0.20-1.01). The proportion of participants reporting hazardous alcohol use and several sexual risk behaviors was higher during clinic closures than after clinic reopening. In multivariable analysis adjusting for study site and participant characteristics, HIV incidence was lower after clinic reopening (IRR 0.57, 95%CrI = 0.23-1.33). Independent risk factors for HIV acquisition included receptive anal intercourse (IRR 1.94, 95%CrI = 0.88-4.80) and perceived risk of HIV (IRR 3.03, 95%CRI = 1.40-6.24). CONCLUSIONS: HIV incidence during COVID-19-related clinic closures was moderately increased and reduced after COVID-19 restrictions were eased. Ensuring access to services for key populations is important during public health emergencies.