The benefits of continuing to provide HIV services during the COVID-19 pandemic far outweigh the risk of additional COVID-19-related deaths, a mathematical modelling study has found. The analysis, which was supported by UNAIDS and the World Health Organization (WHO), shows that maintaining HIV services would avert 19 to 146 AIDS-related deaths per 10,000 people over 50 years, compared with 0.002 to 0.15 per 10,000 additional COVID-19-related deaths from exposures during HIV services. The study examined disruptions to four key HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing, and programmes to prevent mother-to-child transmission of HIV (WHO, 13 April 2021).
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Zimbabwe has reached the 90–90–90 targets set by UNAIDS for 2020 — 90% of people knowing their HIV status, 90% of those diagnosed with HIV on antiretroviral treatment, and 90% of those receiving treatment achieving viral suppression — and is working toward the 95–95–95 targets for 2025, The Herald reports. The chief executive officer of the National AIDS Council is quoted as saying that the country was able to achieve 90–90–90 as a result of increased access to HIV testing services and their integration with other HIV prevention services, such as voluntary medical male circumcision, pre-exposure prophylaxis, and post-exposure prophylaxis. The latest Global AIDS Report also shows that AIDS-related deaths in Zimbabwe fell by more than 28% from 2015 to 2020, missing the goal of a 50% reduction (The Herald, 5 April 2021).
Home-based testing and universal treatment for HIV are cost-effective and can reduce new infections in high-prevalence communities, according to a modelling study published in The Lancet Global Health. The modellers analysed data from PopART, a major study of combination HIV prevention involving more than 1 million people in South Africa and Zambia from 2013 to 2018. The analysis showed that in settings with high rates of HIV, community health workers can deliver a package of HIV interventions for less than $US 8 per person per year. The interventions included door-to-door home-based HIV counselling and testing; linkage to care; promotion of adherence to antiretroviral therapy; and voluntary medical male circumcision (Medical Xpress, 15 March 2021).
About 26,000 new HIV infections have been prevented among Zambian men due to uptake of voluntary medical male circumcision (VMMC) since 2007, the Zambia Daily Mail reports. In a speech he read for the Minister of Health at the virtual launch of the VMMC National Operational Plan for 2021-2025, the Ministry of Health Permanent Secretary for Technical Services announced that more than 3 million men had received VMMC services from 2007 to 2020. Senior Chief Madzimawe of the Ngoni people in Zambia’s Eastern Province commended the government’s efforts to prevent HIV and AIDS through VMMC (Zambia Daily Mail, 12 February 2021).
A rapid response to adapt services to follow COVID-19 safety guidelines enabled the Tohara Plus team to provide voluntary medical male circumcision (VMMC) services to more than 186,000 men and boys in four northern regions of Tanzania in 2020. The project, which is led by IntraHealth and funded by the U.S. President’s Plan for AIDS Relief (PEPFAR) and the U.S. Centers for Disease Control and Prevention, was able to continue providing services during the COVID-19 pandemic at 71 sites in the regions of Shinyanga, Mara, Mwanza, and Simiyu. Client follow-ups were reviewed daily, and clients who missed their appointments were reached through their mobile phone numbers and reminded to reschedule. In 2020, 99 percent of clients returned for a post-circumcision follow-up appointment within 14 days, and almost 92 percent of clients returned for a second follow-up visit (IntraHealth International, 8 February 2021).
Communities in some parts of Zambia have long practiced traditional circumcision as a rite of passage for young men, but interest in male circumcision performed by medical practitioners is growing, Xinhua News reports. The article, based on interviews conducted with men in Lusaka and Central Province, quotes several satisfied clients on their positive experiences with the procedure. A community health worker who was also interviewed attributed the increasing interest in medical male circumcision to its benefits but also cautioned that the procedure does not offer total protection against HIV and should not be considered a license to engage in risky behaviour (Xinhua, 31 January 2021).
A full package of effective HIV prevention interventions must be offered to people taking part in HIV prevention trials under new guidance from UNAIDS and the World Health Organization (WHO), Aidsmap reports. The guidance clarifies that researchers must ensure access to all the standard prevention methods recommended by WHO even if one or more of those methods is not routinely available in the country where the research is being conducted. The current package includes male condoms, female condoms, lubricants, post-exposure prophylaxis, oral pre-exposure prophylaxis, vaginal rings, treatment of sexually transmitted infections, and (in eastern and southern Africa only) voluntary medical male circumcision. Any departure from this package needs to be based on a compelling rationale and be approved by community representatives and other stakeholders (Aidsmap, 29 January 2021).
With new HIV targets for 2025, UNAIDS aims to put the world back on track to end AIDS as a public health problem by 2030, Avert reports. Despite large increases in the numbers of people accessing HIV testing and treatment, the 2020 global HIV goals were not met, with efforts to increase the use of prevention methods such as pre-exposure prophylaxis and voluntary medical male circumcision falling particularly short. The 2025 targets focus on creating an enabling environment for and increasing access to HIV prevention and treatment services while improving their integration with other essential health services. The 2025 goals will form part of UNAIDS’ new strategy, which officials hope to ratify in early 2021 before United Nations General Assembly High-Level Meeting on Ending AIDS in June (Avert, 22 December 2020).
New modelling shows the COVID-19 pandemic should not be a reason for delaying the 2030 deadline for ending AIDS as a public health threat, UNAIDS reports. The modelling study assessed the impact of potential pandemic-related service disruptions, including less HIV treatment uptake and no voluntary medical male circumcisions, for different time periods, from three months to two years. It found that such disruptions may result in 123,000 to 293,000 additional HIV infections and 69,000 to 148,000 AIDS-related deaths globally. However, these projections suggest that COVID-19’s effects on the HIV response will be relatively short-lived, and therefore meeting the 2030 target is still possible (UNAIDS news release, 14 December 2020).
VMMCs performed by nurses are safe and have become standard practice in most VMMC settings, the authors of a new systematic and policy review say in this podcast from the Journal of the Association of Nurses in AIDS Care. However, many countries have not yet aligned national nursing and midwifery regulations with national VMMC policies to provide clear authorization for nurses and midwives to provide VMMC services, their review found. The study was published in the Journal of the Association of Nurses in AIDS Care (JANAC Podcast, December 2020).
Health authorities and organisations conducting voluntary medical male circumcision in South Africa say the numbers of men and boys being medically circumcised have dropped dramatically during the COVID-19 pandemic, Spotlight reports. Provision of VMMCs and other elective surgeries was suspended during a nationwide COVID-related lockdown in March 2020. With the easing of the lockdown, the suspension was lifted in late June, but only for a low volume of male circumcisions in areas that are not COVID-19 hotspots. Data from the National Department of Health show that in the first three quarters of 2020, 111,766 VMMCs were conducted in South Africa, compared to 411,063 in the first three quarters of 2019 — a 73% decline [Spotlight, 25 November 2020].
More than 10 years of further evidence that voluntary medical male circumcision (VMMC) for HIV prevention is having a substantial effect in real-world settings guided the development of new World Health Organization (WHO) guidelines, according to a news release. The updated VMMC guidelines present the latest evidence on the impact and cost-effectiveness of continuing VMMC services as part of combination prevention for men and adolescent boys ages 15 years and older, the safety of the use of prequalified devices to perform male circumcision, and interventions to enhance uptake of VMMC services among men. They also examine factors to consider when deciding whether to offer VMMC to younger adolescent boys (ages 10 to 14 years), including diversity in physical and cognitive development and the capacity to consent. The guidelines outline a framework to guide health systems as they transition from dedicated VMMC services to more integrated, adolescent-focused services designed to sustain high VMMC coverage and address other health care needs (AllAfrica, 21 August 2020).
As South Africa went into a coronavirus lockdown in March, non-emergency procedures such as voluntary medical male circumcision (VMMC) were stopped. Many of the organisations providing VMMC services began supporting COVID-19 screening and testing, and their teams quickly saw a need to apply lessons from their HIV prevention experience. In a comment published by Bhekisisa, the head of one of those organisations writes that “time-tested lessons … about building community trust and battling misinformation are just as important in today’s COVID-19 response as they have been to us in the HIV field for the past two decades” (Bhekisisa, 22 June 2020).
Measures to prevent COVID-19 have slowed down Zimbabwe’s voluntary medical male circumcision (VMMC) programme, the Chronicle reports. To avert new HIV infections, the country’s Ministry of Health and Child Care (MOHCC) aims to circumcise about 400,000 men in 2020. As of April 2020, however, only 37,060 men had been circumcised. The director of the HIV, AIDS and TB Unit in the MOHCC is quoted as saying that the VMMC programme’s goal for the year is achievable despite the challenges posed by the COVID-19 pandemic (Chronicle [Zimbabwe,] 15 June 2020).
The U.S. Centers for Disease Control and Prevention (CDC) and Project ECHO are hosting a weekly webinar series about infection prevention and control (IPC) in the context of COVID-19 every Thursday through 6 August 2020 from 9:00–10:30 a.m. EDT and from 12:00–1:30 p.m. CST. Speakers from CDC, the World Health Organization, and IPC professional societies will focus on practical advice and implementation considerations for IPC in health care settings. These 90-minute sessions will provide equal time for presentations and discussion. IPC professionals, Ministry of Health staff, partner organizations, and any interested healthcare workers are encouraged to participate. Please contact IPCECHO@salud.unm.edu for registration information.
Practical IPC Considerations in the Fight Against COVID-19: Webinar Topics
• Healthcare facility readiness and monitoring
• Healthcare worker risk assessment, monitoring, and other staff considerations
• Assessing SARS-CoV-2 infection among healthcare workers and inpatients
• Cleaning and disinfection in the context of COVID-19
• WASH in healthcare settings in the context of COVID-19
• Limiting the introduction of COVID-19 in healthcare settings
• Rational use of personal protective equipment and emergency strategies
• Advice on the use of medical and non-medical masks
• IPC in nursing homes and long-term care settings
• Considerations for SARI treatment centers
• Post-mortem considerations in context of COVID-19