Impact of COVID-19 on adolescent girls and young women in a community-based HIV prep programme in south africa

Peters, R.; Medina-Marino, A.; Celum, C.; Bekker, L.

Background The coronavirus (COVID-19) pandemic has severely impacted healthcare service delivery, including preexposure prophylaxis (PrEP) worldwide. COVID-19 may increase the vulnerability of adolescent girls and young women (AGYW). We investigated the impact of COVID-19 on HIV, STIs and pregnancy in a community-based PrEP programme for AGYW in South Africa. Methods We used data from an ongoing study of strategies to improve the prevention-effective use of PrEP among AGYW living in a peri-urban and a rural community in the Eastern Cape, South Africa. PrEP services have been provided since October 2018;AGYW are expected to attend monthly PrEP service activities with Xpert® testing for STIs at the 6-, 12- and 24-months visits. PrEP services were partially impacted during the South African lockdown (March-April 2020). An observational analysis of PrEP service utilization and HIV, STI and pregnancy results was conducted comparing data from before COVID-19 introduction and during the COVID-19 epidemic in South Africa. Results A total of 546 AGYW attending PrEP services for ≥3 months were included in our analysis. The number of AGYW visits for PrEP and HIV testing dropped by 29% (p<0.001) during the COVID-19 epidemic in South Africa. HIV test positivity increased from 0.54% to 1.94% during the COVID-19 epidemic (p=0.03). STI test positivity increased from 23 to 30% (p=0.20) for Chlamydia trachomatis, 7% to 14% for Neisseria gonorrhoeae (p=0.08), and 8 to 12% for Trichomonas vaginalis (p=0.32). Pregnancy test positivity increased from 1.2% before to 4.1% during the COVID-19 epidemic (p=0.002). Conclusion South African AGYW substantially decreased their visits for PrEP in a community-based PrEP study during the COVID-19 epidemic, while rates of new HIV infection, STIs, and pregnancy increased, indicating unprotected sex. The impact of COVID-19 on healthcare services, the economy and social interactions has enhanced the vulnerability and health risks of AGYW in our setting.