Intersecting epidemics: COVID-19 and HIV in sub-Saharan Africa. A systematic review (2020-2022)
Accepted: 14 May 2023
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background. There has been significant progress with regards to winning the fight against HIV globally, particularly due to the introduction of antiretroviral therapy (ART). COVID-19 threatened to derail gains in the fight against HIV. As we have started to see with studies on COVID-19 and HIV, there is a need to "provide an in-depth view" in understanding the dynamics between the two epidemics, especially in sub-Saharan Africa. We, therefore, undertook a systemic review of existing literature to synthesize the effects of COVID-19 on the utilization of HIV services in sub-Saharan Africa, the literature on the risks associated with HIV during the COVID-19 pandemic, and lastly, the innovations and strategies adopted to continue receiving treatment in sub-Saharan Africa.
Methods. We conducted a systematic review of studies published between 2020 and April 2022. We searched for relevant sub-Saharan studies in the following databases: PubMed, Google Scholar, J-STOR, and Science Direct. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search identified 647 papers, and after screening, 41 were in line with the inclusion criteria and were included in the review.
Results. There was evidence of the negative effects of COVID-19 on reducing HIV testing, ART treatment, and HIV prevention services. There is evidence pointing to the need for people living with HIV to be prioritized for COVID-19 vaccinations. Innovations and strategies implemented to mitigate the effects of COVID-19 on HIV services include community-based ART distribution, multi-month ART dispensing, the use of digital technologies, and the use of the already existing HIV infrastructure to fight COVID-19.
Conclusion. It is still imperative that future studies explore the predictors of utilization of HIV services in the advent of COVID-19.
UNAIDS. Global HIV & AIDS statistics — 2020 fact sheet [Internet]. 2020 [cited 2021 Jan 24]. Available from: https://www.unaids.org/en/resources/fact-sheet
Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature. 2020;
Boulle AA, Davies M, Hussey H, Morden E, Vundle Z, Zweigenthal V, et al. Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa. Clin Infect Dis. 2020; DOI: https://doi.org/10.1101/2020.07.02.20145185
Purdy C. How will COVID-19 affect global access to contraceptives and what can we do about it? Devex. 2020;
Riley T, Sully E, Ahmed Z, Biddlecom A. Estimates of the potential impact of the covid-19 pandemic on sexual and reproductive health in low-and middle-income countries. Vol. 46, International Perspectives on Sexual and Reproductive Health. 2020. DOI: https://doi.org/10.1363/46e9020
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Vol. 372, The BMJ. 2021. DOI: https://doi.org/10.1136/bmj.n71
Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol Theory Pract. 2005;8(1). DOI: https://doi.org/10.1080/1364557032000119616
Mendeley. Getting started with Mendeley [Internet]. 2021. Available from: https://www.mendeley.com/guides/mendeley-cite
Lagat H, Sharma M, Kariithi E, Otieno G, Katz D, Masyuko S, et al. Impact of the COVID-19 pandemic on HIV testing and assisted partner notification services, Western Kenya. AIDS Behav. 2020;24(11):3010–3. DOI: https://doi.org/10.1007/s10461-020-02938-7
Ponticiello M, Mwanga-Amumpaire J, Tushemereirwe P, Nuwagaba G, King R, Sundararajan R. “Everything is a Mess”: how COVID-19 is impacting engagement with HIV testing services in rural Southwestern Uganda. AIDS Behav. 2020;24(11):3006–9. DOI: https://doi.org/10.1007/s10461-020-02935-w
World Health Organization. Assessment of HIV testing services and antiretroviral therapy service disruptions in the context of COVID-19: lessons learned and way forward in sub-Saharan Africa. 2021;
Harris TG, Jaszi E, Lamb MR, Laudari CA, Furtado MLM, Nijirazana B, et al. Effects of the COVID-19 Pandemic on HIV Services: Findings from 11 Sub-Saharan African Countries. Clin Infect Dis [Internet]. 2021 Nov 15 [cited 2021 Dec 1]; Available from: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab951/6428385
Dorward J, Khubone T, Gate K, Ngobese H, Sookrajh Y, Mkhize S, et al. The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: an interrupted time series analysis. Lancet HIV. 2021;8(3). DOI: https://doi.org/10.1016/S2352-3018(20)30359-3
Assefa N, Sié A, Wang D, Korte ML, Hemler EC, Abdullahi YY, et al. Reported Barriers to Healthcare Access and Service Disruptions Caused by COVID-19 in Burkina Faso, Ethiopia, and Nigeria: A Telephone Survey. Am J Trop Med Hyg. 2021 Jun;105(2):323–30. DOI: https://doi.org/10.4269/ajtmh.20-1619
Dear N, Duff E, Esber A, Parikh A, Iroezindu M, Bahemana E, et al. Transient reductions in HIV clinic attendance and food security during the COVID-19 pandemic for people living with HIV in four African countries. Clin Infect Dis. 2021;27.
Ahmed SAKS, Ajisola M, Azeem K, Bakibinga P, Chen Y-F, Choudhury NN, et al. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Heal. 2020 Aug;5(8). DOI: https://doi.org/10.1136/bmjgh-2020-003042
Pierre G, Uwineza A, Dzinamarira T. Attendance to HIV antiretroviral collection clinic appointments during COVID-19 Lockdown. A single center study in Kigali, Rwanda. AIDS Behav. 2020;24(12):3299–301. DOI: https://doi.org/10.1007/s10461-020-02956-5
Bell D, Hansen KS, Kiragga AN, Kambugu A, Kissa J, Mbonye AK. Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda. Am J Trop Med Hyg. 2020 Sep;103(3):1191–7. DOI: https://doi.org/10.4269/ajtmh.20-0546
Umviligihozo G, Mupfumi L, Sonela N, Naicker D, Obuku EA, Koofhethile C, et al. Sub-Saharan Africa preparedness and response to the COVID-19 pandemic: A perspective of early career African scientists. Wellcome open Res. 2020;5:163. DOI: https://doi.org/10.12688/wellcomeopenres.16070.2
Chanda-Kapata P, Ntoumi F, Kapata N, Lungu P, Mucheleng’anga LA, Chakaya J, et al. Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa - A Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2022 Mar; DOI: https://doi.org/10.1016/j.ijid.2022.03.033
Coker M, Folayan MO, Michelow IC, Oladokun RE, Torbunde N, Sam-Agudu NA. Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa. Pediatr Res. 2021 Apr;89(5):1078–86. DOI: https://doi.org/10.1038/s41390-020-01174-y
Murewanhema G. HIV and Sub-Saharan African Women in the COVID-19 Era and beyond. Int J Med Rev. 2021;8(2):74–9.
Joseph Davey D, Bekker L-G, Coates TJ, Myer L. Contracting HIV or Contracting SAR-CoV-2 (COVID- 19) in Pregnancy? Balancing the Risks and Benefits. Vol. 24, AIDS and behavior. 2020. p. 2229–31. DOI: https://doi.org/10.1007/s10461-020-02861-x
Jewell BL, Mudimu E, Stover J, Ten Brink D, Phillips AN, Smith JA, et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. lancet HIV. 2020 Sep;7(9):e629–40. DOI: https://doi.org/10.1016/S2352-3018(20)30211-3
Jewell BL, Smith JA, Hallett TB. Understanding the impact of interruptions to HIV services during the COVID-19 pandemic: A modelling study. EClinicalMedicine. 2020 Sep;26:100483. DOI: https://doi.org/10.1016/j.eclinm.2020.100483
Velavan TP, Meyer CG, Esen M, Kremsner PG, Ntoumi F. COVID-19 and syndemic challenges in “Battling the Big Three”: HIV, TB and malaria. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2021 May;106:29–32. DOI: https://doi.org/10.1016/j.ijid.2021.03.071
Stover J, Chagoma N, Taramusi I, Teng Y, Glaubius R, Mahiane G. Estimation of the potential impact of COVID-19 responses on the HIV epidemic: analysis using the goals model. MedRxiv. 2020; DOI: https://doi.org/10.1101/2020.05.04.20090399
Phiri D, Salekin S, Nyirenda VR, Simwanda M, Ranagalage M, Murayama Y. Spread of COVID-19 in Zambia: An assessment of environmental and socioeconomic factors using a classification tree approach. Sci African. 2021 Jul;12:e00827. DOI: https://doi.org/10.1016/j.sciaf.2021.e00827
Snyman J, Sanders EJ, Ndung’u T. COVID-19 in Africa: Preexisting immunity and HIV. AIDS. 2021;35(14):2391. DOI: https://doi.org/10.1097/QAD.0000000000003079
Stover J, Kelly SL, Mudimu E, Green D, Smith T, Taramusi I, et al. The risks and benefits of providing HIV services during the COVID-19 pandemic. PLoS One. 2021;16(12):e0260820. DOI: https://doi.org/10.1371/journal.pone.0260820
Mandala WL, Liu MKP. SARS-CoV-2 and HIV-1: Should HIV-1-Infected Individuals in Sub-Saharan Africa Be Considered a Priority Group for the COVID-19 Vaccines? Front Immunol. 2021;12:797117. DOI: https://doi.org/10.3389/fimmu.2021.797117
Nepomuceno M. Vulnerable groups at increased risk of COVID-19 in sub-Saharan Africa: The case of the HIV population. 2020; DOI: https://doi.org/10.31235/osf.io/9gpw8
Himwaze CM, Telendiy V, Maate F, Mupeta S, Chitalu C, Chanda D, et al. Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy Series. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2021 Jul;108:363–9. DOI: https://doi.org/10.1016/j.ijid.2021.06.013
Bell D, Schultz Hansen K. Relative Burdens of the COVID-19, Malaria, Tuberculosis, and HIV/AIDS Epidemics in Sub-Saharan Africa. Am J Trop Med Hyg. 2021 Oct;105(6):1510–5. DOI: https://doi.org/10.4269/ajtmh.21-0899
Osibogun A, Balogun M, Abayomi A, Idris J, Kuyinu Y, Odukoya O, et al. Outcomes of COVID-19 patients with comorbidities in southwest Nigeria. PLoS One. 2021;16(3):e0248281. DOI: https://doi.org/10.1371/journal.pone.0248281
Venturas J, Zamparini J, Shaddock E, Stacey S, Murray L, Richards GA, et al. Comparison of outcomes in HIV-positive and HIV-negative patients with COVID-19. J Infect. 2021 Aug;83(2):217–27. DOI: https://doi.org/10.1016/j.jinf.2021.05.020
Jassat W, Cohen C, Tempia S, Masha M, Goldstein S, Kufa T, et al. Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study. lancet HIV. 2021 Sep;8(9):e554–67.
Wilkinson L, Grimsrud A. The time is now: expedited HIV differentiated service delivery during the COVID‐19 pandemic. J Int AIDS Soc. 2020;23(5). DOI: https://doi.org/10.1002/jia2.25503
Grimsrud A, Ehrenkranz P, Sikazwe I. Silver linings: how COVID‐19 expedited differentiated service delivery for HIV. J Int AIDS Soc. 2021;24(Suppl 6). DOI: https://doi.org/10.1002/jia2.25807
Grimsrud A, Wilkinson L. Acceleration of differentiated service delivery for HIV treatment in sub-Saharan Africa during COVID-19. J Int AIDS Soc. 2021 Jun;24(6):e25704. DOI: https://doi.org/10.1002/jia2.25704
Golin R, Godfrey C, Firth J, Lee L, Minior T, Phelps BR, et al. PEPFAR’s response to the convergence of the HIV and COVID-19 pandemics in Sub-Saharan Africa. J Int AIDS Soc. 2020 Aug;23(8):e25587. DOI: https://doi.org/10.1002/jia2.25587
Zakumumpa H, Tumwine C, Milliam K, Spicer N. Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda. BMC Health Serv Res. 2021 Jul;21(1):692. DOI: https://doi.org/10.1186/s12913-021-06607-w
Nyoni T, Okumu M. COVID-19-Compliant Strategies for Supporting Treatment Adherence Among People Living with HIV in Sub-Saharan Africa. Vol. 24, AIDS and behavior. 2020. p. 2473–6. DOI: https://doi.org/10.1007/s10461-020-02888-0
Brault MA, Vermund SH, Aliyu MH, Omer SB, Clark D, Spiegelman D. Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa. Int J Environ Res Public Health. 2021 Oct;18(20). DOI: https://doi.org/10.3390/ijerph182010751
Amimo F, Lambert B, Magit A. What does the COVID-19 pandemic mean for HIV, tuberculosis, and malaria control? Trop Med Health. 2020;48(1):1–4. DOI: https://doi.org/10.1186/s41182-020-00219-6
Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed [Internet]. 2020 [cited 2023 Feb 5];91:157–60. Available from: https://doi.org/10.7326/M20-0504 DOI: https://doi.org/10.7326/M20-0504
Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10). DOI: https://doi.org/10.1007/s11606-009-1068-8
Hogan AB, Jewell BL, Sherrard-Smith E, Vesga JF, Watson OJ, Whittaker C, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Heal. 2020;8(9):e1132–41. DOI: https://doi.org/10.1016/S2214-109X(20)30288-6
Mwananyanda L, Gill CJ, MacLeod W, Kwenda G, Pieciak R, Mupila Z, et al. Covid-19 deaths in Africa: prospective systematic postmortem surveillance study. BMJ. 2021 Feb;372:n334. DOI: https://doi.org/10.1136/bmj.n334
Fernandez D, Godfrey C, Pals SL, Oboho I, Siberry GK, Ali H. Hiv treatment/retention in sub-saharan africa before and during the covid-19 pandemic. Top Antivir Med. 2021;288.
Anjorin AA, Abioye AI, Asowata OE, Soipe A, Kazeem MI, Adesanya IO, et al. Comorbidities and the COVID‐19 pandemic dynamics in Africa. Trop Med Int Heal. 2021;26(1):2–13. DOI: https://doi.org/10.1111/tmi.13504
Govender Y, Shalekoff S, Ebrahim O, Waja Z, Chaisson RE, Martinson N, et al. Systemic DPP4/CD26 is associated with natural HIV-1 control: Implications for COVID-19 susceptibility. Clin Immunol. 2021 Sep;230:108824. DOI: https://doi.org/10.1016/j.clim.2021.108824
Chanda D, Minchella PA, Kampamba D, Itoh M, Hines JZ, Fwoloshi S, et al. COVID-19 Severity and COVID-19-Associated Deaths Among Hospitalized Patients with HIV Infection - Zambia, March-December 2020. MMWR Morb Mortal Wkly Rep. 2021 Jun;70(22):807–10. DOI: https://doi.org/10.15585/mmwr.mm7022a2
Copyright (c) 2023 the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.