Two shocks to the system: Impact of the COVID-19 pandemic on HIV testing and prevention services in KwaZulu-Natal, South Africa
1
Health Research & Knowledge Management, KwaZulu-Natal Department of Health, PIETERMARITZBURG, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A606
ABSTRACT
BACKGROUND:
KwaZulu-Natal (KZN), South Africa, carries the highest burden of HIV globally and has made substantial progress in scaling up HIV testing and treatment services over the past decade.¹ Prior to 2020, sustained improvements in HIV testing coverage and prevention indicators supported progress towards the UNAIDS 95-95-95 targets.² The COVID-19 pandemic disrupted essential health services worldwide, raising concerns about reversals in HIV programme performance.³ This study assessed the impact of COVID-19 on HIV testing, treatment and prevention services in KZN.
METHODS:
A retrospective ecological trend analysis was conducted using routinely collected secondary data from the District Health Information System (DHIS) for KwaZulu-Natal and its 11 districts. Financial year data from 2016/2017 to 2023/2024 were analysed, with 2020/2021 defined as the COVID-19 reference period. Indicators included HIV testing volumes and coverage, HIV positivity, antiretroviral therapy (ART) initiation and retention, condom distribution, medical male circumcision (MMC), pre-exposure prophylaxis (PrEP) uptake, and selected maternal and child HIV indicators.
RESULTS:
HIV testing volumes and coverage declined sharply during the 2020/2021 financial year, followed by partial recovery in subsequent years and a further decline in 2023/2024, consistent with global reports of HIV service disruption during COVID-19.³ ART initiation and prevention services, including condom distribution and MMC, showed similar pandemic-related disruptions, while PrEP uptake increased during the COVID-19 period. Infant HIV positivity at birth increased during 2020/2021, suggesting heightened risk of mother-to-child transmission.⁴ Districts with high population density experienced the greatest absolute declines, while smaller districts demonstrated marked per-capita variability.
CONCLUSIONS:
The COVID-19 pandemic temporarily reversed gains in HIV testing and prevention services in KwaZulu-Natal, diverging from pre-pandemic trends. Strengthening health system resilience through decentralised service delivery, differentiated care models and pandemic preparedness is essential to safeguard HIV programme gains during future public health emergencies.³
KwaZulu-Natal (KZN), South Africa, carries the highest burden of HIV globally and has made substantial progress in scaling up HIV testing and treatment services over the past decade.¹ Prior to 2020, sustained improvements in HIV testing coverage and prevention indicators supported progress towards the UNAIDS 95-95-95 targets.² The COVID-19 pandemic disrupted essential health services worldwide, raising concerns about reversals in HIV programme performance.³ This study assessed the impact of COVID-19 on HIV testing, treatment and prevention services in KZN.
METHODS:
A retrospective ecological trend analysis was conducted using routinely collected secondary data from the District Health Information System (DHIS) for KwaZulu-Natal and its 11 districts. Financial year data from 2016/2017 to 2023/2024 were analysed, with 2020/2021 defined as the COVID-19 reference period. Indicators included HIV testing volumes and coverage, HIV positivity, antiretroviral therapy (ART) initiation and retention, condom distribution, medical male circumcision (MMC), pre-exposure prophylaxis (PrEP) uptake, and selected maternal and child HIV indicators.
RESULTS:
HIV testing volumes and coverage declined sharply during the 2020/2021 financial year, followed by partial recovery in subsequent years and a further decline in 2023/2024, consistent with global reports of HIV service disruption during COVID-19.³ ART initiation and prevention services, including condom distribution and MMC, showed similar pandemic-related disruptions, while PrEP uptake increased during the COVID-19 period. Infant HIV positivity at birth increased during 2020/2021, suggesting heightened risk of mother-to-child transmission.⁴ Districts with high population density experienced the greatest absolute declines, while smaller districts demonstrated marked per-capita variability.
CONCLUSIONS:
The COVID-19 pandemic temporarily reversed gains in HIV testing and prevention services in KwaZulu-Natal, diverging from pre-pandemic trends. Strengthening health system resilience through decentralised service delivery, differentiated care models and pandemic preparedness is essential to safeguard HIV programme gains during future public health emergencies.³
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
