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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) The impact of the COVID-19 pandemic on healthcare services utilization among peo...
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Original article
Available online 14 January 2024
The impact of the COVID-19 pandemic on healthcare services utilization among people living with HIV in Catalonia, Spain: A population-based cohort study
Impacto de la pandemia de COVID-19 en la utilización de los servicios sanitarios entre las personas que viven con el VIH en Cataluña, España: estudio de cohortes de base poblacional
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Yi-Hua Pana,1, Daniel K. Nomaha,b,1,
Corresponding author
dnomah@igtp.cat

Corresponding authors.
, Marcos Montoro-Fernandeza,b, Sergio Moreno-Fornésa,b,c, Yesika Díaza,b,c, Jordi Aceitóna,b, Andreu Brugueraa,b,c, Josep M. Llibred, Pere Domingoe, Arkaitz Imazf, Ingrid Vilaróg, Vicenç Falcóh, Juliana Reyes-Urueñaa, José M. Miroi,j,2,
Corresponding author
jmmiro@ub.edu

Corresponding authors.
, Jordi Casabonaa,b,c,2, the PISCIS Cohort Study Group
a Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya, Badalona, Spain
b Institut d’Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
c CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
d Hospital Universitari Germans Trias i Pujol, Badalona, Spain
e Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
f Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
g Hospital de Vic, Vic, Spain
h Vall d’Hebron Research Institute (VHIR), Hospital de Vall d’Hebron, Barcelona, Spain
i Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
j CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Table 1. Baseline characteristics of people living with HIV in Catalonia during the different study periods, 2017–2020.
Table 2. Number of visits among people living with HIV in Catalonia in health facilities during four study periods, 2017–2020.
Table 3. Comparison of the average number of monthly visits among PLWH in Catalonia from 2017 to 2019 to visits in 2020 stratified by health facility types. (A) Number of monthly medical visits from January to June and (B) number of monthly medical visits from July to December.
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Abstract
Background

The COVID-19 pandemic disrupted healthcare services usage. We estimated the impact of the COVID-19 pandemic on healthcare services utilization among people living with HIV (PLWH) in Catalonia, Spain.

Methods

We accessed public healthcare usage in HIV units, primary care, hospitals, and emergency departments among 17,738 PLWH in the PISCIS cohort from January 1, 2017, to December 31, 2020. We performed an interrupted time series analysis using the autoregressive integrated moving average to estimate the effect of COVID-19 on medical visits and HIV monitoring among PLWH.

Results

A non-significant decrease of 17.1% (95% CI: [−29.4, 0.4]) in overall medical visits was observed during the lockdown, followed by a steady resumption until the end of 2020. Three health facilities presented statistically significant declines in visits during the lockdown: HIV units (−44.8% [−56.7, −23.6]), hospitals (−40.4% [−52.8, −18.1]), and emergency departments (−36.9% [−47.0, −21.9]); thereafter, the visits have begun to increase steadily but not to previous levels as of December 2020. In contrast, primary care visits remained unchanged during the lockdown by 1.9% (95% CI: −13.5, 23.9). CD4 cell (54.2% [95% CI: −64.4, −36.0]) and HIV RNA viral load (53.1% [95% CI: −62.9, −36.1]) laboratory monitoring reduced significantly during the lockdown.

Conclusion

COVID-19 lockdowns significantly disrupted in-person healthcare services usage among PLWH. The reduction in healthcare utilization however did not affect primary care services. Despite services gradually rebounding to pre-pandemic levels, it is imperative to effectively prepare for future pandemics and implement measures to ensure continuous provision of care to PLWH during pandemic lockdowns.

Keywords:
COVID-19
HIV
Lockdown
PLWH
Healthcare service utilization
Interrupted time series
Resumen
Antecedentes

La pandemia de COVID-19 interrumpió el uso de los servicios sanitarios. Estimamos el impacto de la pandemia de COVID-19 en la utilización de los servicios de salud entre las personas que viven con el VIH (PVV) en Cataluña, España.

Métodos

Registramos el uso de la atención médica pública en unidades de VIH, atención primaria, hospitales y centros de urgencias en 17.738PVV de la cohorte PISCIS desde el 1 de enero de 2017 hasta el 31 de diciembre de 2020. Realizamos un análisis de series temporales interrumpidas utilizando el promedio móvil integrado autorregresivo para estimar el efecto de la COVID-19 en las consultas médicas y el seguimiento del VIH entre las PVV.

Resultados

Se observó una disminución no significativa del 17,1% (IC95%: −29,4 a 0,4) en las visitas médicas generales durante el confinamiento, seguida de una reanudación constante hasta finales de 2020. Tres establecimientos de salud presentaron disminuciones estadísticamente significativas en las visitas durante el confinamiento: unidades de VIH (−44,8% [−56,7 a −23,6]), hospitales (−40,4% [−52,8 a −18,1]) y urgencias (−36,9% [−47,0 a −21,9]); a partir de entonces, las visitas han comenzado a aumentar de manera constante, pero no a los niveles anteriores a diciembre de 2020. Por el contrario, las visitas de atención primaria se mantuvieron sin cambios durante el confinamiento en un 1,9% (ICIC 95%: −13,5 a 23,9). El control de las analíticas de células CD4 (54,2% [IC95%: −64,4 a −36,0]) y de la carga viral de ARN del VIH (53,1% [IC95%: −62,9 a −36,1]) se redujo significativamente durante el confinamiento.

Conclusión

Los bloqueos de COVID-19 interrumpieron significativamente el uso de servicios de atención médica en persona entre las PVV. Sin embargo, la reducción en la utilización de la atención sanitaria no afectó a los servicios de atención primaria. A pesar de que los servicios se recuperan gradualmente a los niveles previos a la pandemia, es imperativo prepararse de manera efectiva para futuras pandemias e implementar medidas para garantizar la provisión continua de atención a las PVV durante los bloqueos por pandemia.

Palabras clave:
COVID-19
VIH
Aislamiento
PVV
Uso de servicios de salud
Serie temporal interrumpida

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