Assessing the impact of the COVID-19 pandemic on uptake of HIV treatment in Bandung and Yogyakarta, Indonesia: A retrospective cohort study

COVID-19 pandemic known to affect health service deliveries including for HIV care support and treatment. In this retrospective study involving 2,780 people living with HIV (PLHIV), we evaluated impact of COVID-19 pandemic by comparing the proportion of PLHIV linked to care, started antiretroviral therapy (ART), retained in care (within the first 3 months of treatment), and adhered to ART (within the first 3 months of treatment) between the pre-pandemic period (2018-2019) and pandemic period (2020-2021) in Yogyakarta and Bandung, Indonesia. Our study showed that during the pandemic period the number of PLHIV linked to care was 18% lower (1,529 vs 1,251) and those retained in care was significantly lower (59.6% vs 53.3%, p = 0.0009) than the pre-pandemic period. Whereas, proportion in ART initiation (79.6% vs 78.3%, p = 0.3892) and ART adherence (50.0% vs 46.8%, p = 0.1010) were not statistically different. Multivariate analysis showed that ART initiation (aOR = 1.00, p = 0.996) nor retention in care (aOR = 0.90, p = 0.344) were not significantly different between two period cohorts. Adherence for the first three months of treatment, however, was significantly higher in the pandemic cohort (aOR = 1.53, p = 0.009). In the subgroup analysis, older PLHIV and those attending hospitals (tertiary versus primary care clinics) were significantly less likely to initiate ART, be retained in care, or adhere to ART. This study provides evidence of the impact of the COVID-19 pandemic on several characteristics of the HIV treatment cascade such as lower number of linkage to- and retention in care, lower number of older PLHIV, and attendance to tertiary care (hospital). General and HIV-specific mitigation strategies should be designed to minimise pandemic related disruptions and to support the continuity of HIV care to face possible future health crises.