Experiences of participants in a decentralized antiretroviral therapy program in South Africa during the COVID-19 pandemic

Figures & data

Table 1. Participant demographics. N = 303 unless otherwise stated.

	Median [IQR] or n (%)
Sex
Female	200 (66.0)
Male	103 (34.0)
Age, years	36.0 [31.0-45.0]
18–25	22 (7.3)
26–40	166 (54.8)
>40	115 (38.0)
Years since initiation of ART	3.0 [1.0-6.0]
Education level
No school	6 (2.0)
Primary	34 (11.2)
Some high school	123 (40.6)
Matric	120 (39.6)
Tertiary	20 (6.6)
Employment status
Not employed	164 (54.1)
Employed	139 (45.9)
Marital status
Never married	237 (78.2)
Currently married	58 (19.1)
Divorced/separated	5 (1.7)
Widowed	3 (1.0)
Self-reported ability to take HIV medication, n = 302
Very poor, poor, or fair	0
Good	6 (2.0)
Very good	49 (16.2)
Excellent	247 (81.8)
Barriers to care at baseline, by domain
Service	26 (8.6)
Financial	12 (4.0)
Personal health	1 (0.3)
Logistical	22 (7.3)
Structural	18 (5.9)
No barriers to care	250 (82.5)
Any competing needs at baseline	6 (2.0)
Months enrolled in CCMDD (time elapsed since baseline questionnaire)
0–6 months	150 (49.5)
6–12 months	81 (26.7)
>12 months	72 (23.8)
Remain enrolled in CCMDD program at time of COVID-19 interview
Yes	292 (96.4)
No	9 (3.0)
Refused	2 (0.7)
Distance to usual CCMDD PUP, kilometers; n = 292
<5km	90 (30.8)
5-10km	76 (26.0)
10-30km	60 (20.5)
>30km	55 (18.8)
Unknown	11 (3.8)
Form of travel to CCMDD pick-up point
Walk	137 (45.2)
Public transport (bus, taxi)	150 (49.5)
Private transport	7 (2.3)
Other	2 (0.7)
Time to usual CCMDD pick-up-point, minutes	30.0 [20.0-60.0]
Usual transport cost to CCMDD pick-up point, South African Rand	20.0 [0-21.0]

Figure 1. Concerns about the COVID-19 pandemic. Percentage of participants who reported the following primary concerns about the COVID-19 pandemic. Participants were allowed to select multiple responses. PUP; pick-up point. PPE; personal protective equipment.

Table 2. Barriers to ART access during the COVID-19 pandemic.

ART access outcome	N (%)
Delayed picking up ART due to coronavirus, n = 302	25 (8.3)
New concerns about picking up ART going forward
COVID-19 infection risk	104 (34.3)
Transportation availability	67 (22.1)
Safety concerns	59 (19.5)
Concern or knowledge that pick-up point is closed/no staff present	12 (4.0)
Long queues, delay in being attended to	12 (4.0)
Transportation cost	10 (3.3)
Illness in self or family	10 (3.3)
Busy with work or family	8 (2.6)
Other	22 (7.3)
Experience picking up ART changed, n = 302
Yes	76 (25.2)
No	185 (61.3)
Haven’t been to pick up point recently	39 (12.9)
Refused	2 (0.7)
Pick-up point location changed, n = 76
Yes	12 (15.8)
No	64 (84.2)
Time to pick up point changed, N = 146
No change	86 (28.4) ^Table Footnote§
Increased	44 (14.5)
Decreased	9 (3.0)
Refused	7 (2.3)
Cost to pick-up point changed, n = 148
No change	134 (44.2) ^§
Increased	6 (2.0)
Decreased	3 (1.0)
Refused	5 (1.7)
Wait time to pick up ART, n = 148
No change	34 (11.2) ^§
Increased	75 (24.8)
Decreased	31 (10.2)
Refused	8 (2.6)
Crowding at pick up point, n = 147
Same	41 (13.5) ^§
More crowded	63 (20.8)
Less crowded	33 (10.9)
Refused	10 (3.3)
Treatment at pick-up point, n = 147
Same as usual	107 (35.3)
Worse than usual	7 (2.3) ^§
Better than usual	23 (7.6)
Refused	10 (3.3)
ART in stock, n = 147
Yes	135 (91.8)
No	6 (4.1)
Refused	6 (4.1)
Think date of next ART pick-up will change because of coronavirus, n = 302
Yes	18 (6.0)
No	218 (72.2)
Unsure	65 (21.5)
Refused	1 (0.3)

^§ Denominator for percentages = 303

Table 3. Correlates of concerns about future ART access.

Concern about COVID-19 infection^a with regard to ART access	OR, univariate analyses	p-value	aOR, multivariable analysis	p-value
Female sex	1.27 (0.77-2.09)	0.35	1.65 (0.97-2.83)	0.07
Age (reference, >40 years)
18–25	0.68 (0.25-1.86)	0.45	1.10 (0.35-3.49)	0.87
26–40	1.13 (0.69-1.86)	0.62	1.34 (0.79-2.29)	0.28
Time on CCMDD program (reference, 0–6 months)
6-12mo	0.79 (0.46-1.36)	0.39	0.89 (0.50-1.58)	0.69
>12 mo	0.14 (0.06-0.32)	<0.001	0.14 (0.06-0.33)	<0.001
Time on ART (reference, <1 year)
1–5 years	1.28 (0.50-3.27)	0.61
>5 years	1.22 (0.45-3.33)	0.70
COVID-era social support score^b	2.22 (1.32-3.72)	0.003	1.85 (1.13-3.02)	0.01
Concern about concrete barriers^c with regard to art access	OR, univariate analyses	p-value	aOR, multivariable analysis	p-value
Female sex	1.02 (0.60-1.73)	0.95	0.82 (0.45–1.50)	0.53
Age (reference, >40 years)
18–25	1.70 (0.65-4.45)	0.28	1.61 (0.54-4.79)	0.39
26–40	1.14 (0.66-1.95)	0.64	1.00 (0.55 −1.84)	0.997
Time on CCMDD program (reference, 0–6 months)
6-12mo	0.55 (0.29–1.03)	0.06	1.01 (0.46-2.23)	0.99
>12 mo	0.64 (0.34-1.21)	0.17	0.95 (0.40-2.26)	0.90
Distance to pick-up point (reference, <5 km)
5-10km	1.97 (0.90-4.33)	0.09	1.99 (0.89-4.47)	0.09
10-30km	1.80 (0.78-4.17)	0.17	1.84 (0.71-4.74)	0.21
>30km	6.14 (2.79-13.54)	<0.001	6.30 (2.46-16.14)	<0.001
Any baseline competing needs	2.71 (0.54-13.71)	0.23
Baseline healthcare barriers (reference, 0 barriers)	1.11 (0.83-1.48)	0.48
Baseline social support score^b	0.97 (0.70-1.35)	0.86
COVID-era social support score^b	1.11 (0.76-1.63)	0.60

^a includes “COVID-19 infection risk,” “illness in self,” or “illness in family”

^b per 25-point increase in transformed 0–100 score

^c includes “transport availability,” “transport cost,” concern that pick-up point is closed,” or “pick-up point is closed/no staff present”

ART, antiretroviral therapy; CCMDD, central chronic medicines dispensing and distribution; OR, odds ratio; aOR, adjusted odds ratio.

Figure 2. Mental health at baseline and during the COVID-19 pandemic. 2a-2b. Distribution of scores on an adapted 4-item mental health instrument at enrollment into the parent study (baseline) and during the COVID-19 pandemic. 2c. Percentage of participants attributing feelings of nervousness or sadness to the COVID-19 pandemic. 2d. Comparison of median mental health scores at baseline and during the COVID-19 pandemic. 2e-2 h. Median mental health scores during the COVID-19 pandemic compared by subgroup.