Impact of COVID-19 Public Health Measures on Antiretroviral Therapy Use Among Ugandans Living with HIV in Sero-Different Couples

Antiretroviral therapy (ART) use and HIV suppression among people living with HIV (PLHIV) are critical for HIV control and prevention. Extreme restrictions on movement early during the COVID-19 pandemic in Uganda may have impeded the ability to initiate and sustain access to and use of ART. From our stepped-wedge cluster-randomized trial of an integrated PrEP and ART intervention for HIV-serodifferent couples at 12 ART clinics in Uganda, we identified participants who enrolled and had a 6-month post-ART initiation viral load measured before the beginning of the first COVID-19 lockdown (Period 1), participants whose enrollment and 6-month viral load measurement straddled pre-COVID and COVID lockdown times (Period 2), and participants whose enrollment and 6-month viral load were quantified entirely during COVID-19 (Period 3). ART and viral load data were abstracted from standard-of-care HIV clinic records. We used adjusted generalized estimating equation models to compare viral suppression between the different periods. We enrolled 1,381 PLHIV, including 896 (64.9%) in Period 1, 260 (18.8%) in Period 2, and 225 (16.3%) in Period 3. Almost all (1371, 99.3%) initiated ART within 90 days of enrollment and 59.2% had baseline CD4 > 350 cells/mm³. Among those enrolled, 88.8% of participants in Period 1 were virally suppressed (< 1000 copies/mL) within six months of ART initiation, 80.5% in Period 2, and 88.2% in Period 3. All pairwise comparisons demonstrated statistically similar levels of viral suppression. Despite COVID-19 lockdown measures, PLHIV in serodifferent partnerships successfully initiated ART and attained and maintained viral suppression.