National Impact of SARS-CoV-2 Infection on HIV Virological Suppression in South Africa

Abstract

Background: Coronavirus disease (COVID-19) severely disrupted routine health care globally. This study assessed the impact of successive COVID-19 waves on HIV viral load (VL) suppression in South Africa, using the national public sector laboratory database. Guidelines recommend VL monitoring at 6 months after treatment initiation, annually once if suppressed, or more frequently if unsuppressed. Methods: Specimen-level VL data were extracted for the period January 2019–December 2021. We assessed the national percentage of samples with a VL <50 (virological suppression), 50–999 (low-level viremia), and ≥1000 (viremia) copies/mL. Data were analyzed by calendar year and month. Data for 2019 (pre–COVID-19) were compared with the 2020 and 2021 calendar years (lockdowns imposed). The national number of COVID-19 cases was reported to indicate the wave periods as follows: 1 (ancestral)-June–August 2020; 2 (Beta)-December 2020–January 2021; 3 (Delta)-June–August 2021, and 4 (Omicron)-December 2021. Results: Data are reported for 17,460,264 samples, with 5,608,733, 5,840,056, and 6,011,475 tests performed in 2019, 2020, and 2021 respectively. Overall, a VL of <50, 50–999, and ≥1000 copies/mL were reported for 69.4%, 17.3%, and 13.4% of samples, respectively. A VL <50 copies/mL was reported for 67.7%, 70.3%, and 70.0% of patients in 2019, 2020, and 2021, respectively. For the 2020 and 2021 calendar years, the monthly percentage of patients with a VL <50 copies/mL ranged between 64.6% and 72.7%. Conclusion: Our findings indicate that COVID-19 has not had a substantial impact on the percentage of samples with virological suppression at the national level.