The impact of COVID-19 on HIV treatment and care delivery in South and Southeast Asia: a qualitative study

Abstract

The COVID-19 pandemic has significantly impacted HIV treatment worldwide, but its effects on South and Southeast Asia, particularly in India, Indonesia, and Thailand, have been less evident. Our aim was to study the perceptions of providers and policymakers to understand how interventions were implemented as part of pandemic responses and how their effectiveness was viewed. We conducted a qualitative study with semi-structured interviews focusing on the shifts in HIV care in response to the pandemic. Between June and July 2021, 40 individuals were invited for interviews; 33 (83%) agreed. Participants included 25 (76%) providers and 8 (24%) policymakers, who were from India (10; 30%), Indonesia (10; 30%), and Thailand (10; 30%), along with 3 (9.1%) regional policymakers. Sixteen (48%) were female. Our findings revealed four major themes: (1) limitations in accessing HIV care due to movement restrictions and shutdowns, such as transportation issues; (2) diversion of healthcare resources away from HIV care to COVID-19 responses, leading to reallocation of providers and hospital space; (3) setbacks in HIV-related policy implementation as COVID-19 emergency responses took priority; (4) the expansion of HIV differentiated service delivery interventions, allowing longer gaps between visits and larger-volume prescription refills to delay returns to healthcare facilities. These changes have raised concerns about the long-term consequences on HIV epidemic control and future pandemic responses. However, they have also presented opportunities for innovative care delivery, which should be sustained to address these challenges effectively.

Keywords:

• Human immunodeficiency virus
• COVID-19
• pandemic
• South Asia
• Southeast Asia

Acknowledgments

We would like to thank our study participants, Noweed Charles and the amfAR’s TREAT Asia team in Bangkok, and Dr. Madhavi Dandu of the UCSF Global Health Sciences program for their support for the study.

Disclosure statement

AHS receives grants to her institution from ViiV Healthcare. Other authors report no competing interests to declare.

Data availability statement

The data are not publicly available due to participants not providing informed consent for the interview transcripts to be shared publicly.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.