Davorka Lukas

Ivana Benković

Ivana Javorić

Josip Begovac

Nikolina Bogdanić

Sanja Belak Škugor

Šime Zekan

Croatian

Hrčak - Portal of scientific journals of Croatia

79INFEKTOL GLASN 2020;40(2):79-80Pismo uredniku | Letter to the EditorInitial impact of COVID-19 epidemic on HIV services in CroatiaInicijalni učinak epidemije bolesti COVID-19 na HIV usluge u HrvatskojNikolina Bogdanić1, Ivana Javorić1, Sanja Belak Škugor1, Šime Zekan1,2, Davorka Lukas1,2, Ivana Benković1, Josip Begovac1,21 University Hospital for Infectious Diseases „Dr. Fran Mihaljević”, Zagreb, Croatia2 University of Zagreb, School of Medicine, CroatiaDear Editor, We aimed to quantify the impact of COVID-19 epidemic on HIV servic-es in the Republic of Croatia. The Republic of Croatia (population 4.1 mil-lion) has a low-level HIV epidemic driven by men who have sex with men (MSM)[1]. HIV care is centralized, and all people living with HIV (PLWHIV) are treated at the University Hospital for Infectious Diseases (UHID) in Za-greb; the hospital pharmacy dispenses antiretrovirals to all PLWHIV[2]. A phone consultation service was established in 2006 and an mHealth plat-form (EMERGE) has been in use since April 2017 (https://www.emergepro-ject.eu)[3]. UHID is the only centre in Croatia that has a Sexual Health Clinic for MSM (MSM-SHC) and provides HIV pre-exposure prophylaxis (PrEP), and also runs a voluntary counselling and HIV testing (VCT) service. The COVID-19 epidemic in Croatia started on February 26, 2020 and many measures were introduced: quarantine for travellers, isolation for those testing positive and their contacts, suspension of schools and univer-sities (March 16), prohibition of gatherings of more than 5 persons (March 19), cessation of intracity (March 21) and intercity (March 23) transport. Croatia has so far avoided a larger COVID-19 epidemic. Since UHID also became the central hospital for treatment of COVID-19 in the Zagreb area, we investigated how the COVID-19 epidemic has impacted HIV services.Keywords: Covid-19  coronavirus  SARS-CoV-2  HIV care  pre-exposure prophylaxis  voluntary testing and counsellingPrimljeno: 20-4-2020Received: 20-4-2020Prihvaćeno: 27-4-2020Accepted: 27-4-2020* Correspondence:University Hospital for Infectious Diseases  „Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia Nikolina Bogdanić, MDe-mail: nikolinabogdanic@gmail.com We reviewed data from all interactions of PLWHIV with the HIV treatment centre and data on the usage of other services (PrEP, MSM-SHC and VCT) from February 3rd till April 5th. The following was analysed: phone interactions, office visits, number of viral load tests performed and interactions that resulted in dis-pensing antiretrovirals (ART). Data on COVID-19 patients were extracted from the official governmen-tal reports (https://www.koronavirus.hr/) and on HIV care from the local electronic database. With the rise in COVID-19 cases, an increasing number of phone consultations occurred (Figure 1). A total of 2068 phone consultations were made, an aver-age of 190 per week in February (February 3 to March 1) and 261 per week in March (March 2 to April 5). There were 322 office visits, on average 46 per week in February and 22.5 per week in March. There was a decline in viral load measurement from a weekly aver-age of 44 in February to 20 in March (Figure). A total of 2528 1-month supplies of ART were dispensed, of which an average of 248 packages per week were dis-pensed in February and 307 in March. A total of 189 home deliveries of ART for PLWHIV outside Zagreb were made, of which an average of 8.5 shipments per week were made in February and 31 shipments per week in March. So far, we are aware of two cases of treatment interruptions. Our PrEP service had a 50% decline in visits (12 versus 6 visits per week in February and March, re-spectively). VCT counselling sessions declined from 17.5 per week in February to 5 per week in March. Our MSM-SHC service closed on March 9. At the beginning of the COVID-19 epidemic an in-tensification of phone consultations was observed. The ART supplies were regular with more home delivery, and a decline in viral load measurements occurred. Instead of the planned expansion of the PrEP service, a decline in visits happened. Besides a sharp decline in HIV testing at our centre, both community-based centers for HIV testing in Zagreb (CheckPoint and INFEKTOL GLASN 2020;40(2):79-80    Nikolina Bogdanić et al.    Covid-19 epidemic and HIV services80Iskorak) closed (on March 19). We were not able to continue to operate the MSM-SHC. In conclusion, HIV care has mainly focused on de-livery of ART. The emergence of the COVID-19 pan-demic may slow the progress towards achieving the end of HIV/AIDS in Croatia. Actions should be un-dertaken to address those issues.Acknowledgment: This paper was supported by the Croatian Science Foundation Project no. IP-2019-04-9702 (principal in-vestigator: Josip Begovac).REFERENCES [1] European Centre for Disease Prevention and Control and World Health Organization. HIV/AIDS surveillance in Eu-rope 2019. Available at: euro.who.int/en/health-topics/com-municable-diseases/hivaids/publications/2019/hivaids-sur-veillance-in-europe-2019. Accessed April 6, 2020. [2] Romih V, Zidovec Lepej S, Gedike K, Lukas D, Begovac J. Fre-quency of HIV-1 viral load monitoring of patients initially suc-cessfully treated with combination antiretroviral therapy. PLoS One, 2010; 5:e15051. [3] Marent B, Henwood F, Darking M, Em EC. Development of an mHealth platform for HIV Care: Gathering User Perspec-tives Through Co-Design Workshops and Interviews. JMIR Mhealth Uhealth, 2018; 6:e184.Figure1. Number of viral load tests done and phone consultations per week during the initial phase of COVID-19 epidemic in Croatia. Week 1 starts on February 3rd and Week 9 ends on April 5th.Slika 1. Broj testova za mjerenje količine virusa u krvi i telefonske konzultacije na tjednoj bazi tijekom inicijalne faze epidemije bolesti COVID-19 u Hrvatskoj. Tjedan 1. počinje 3. veljače, a tjedan 9. završava 5. travnja.

Initial impact of COVID-19 epidemic on HIV services in Croatia

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Initial impact of COVID-19 epidemic on HIV services in Croatia

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