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Assessing the impact of COVID-19 on HIV services in the Philippines - NU/LSHTM project

Title of PhD project / theme

Assessing the impact of COVID-19 on HIV services in the Philippines

Supervisory team

Marco Liverani (lead, LSHTM) – marco.liverani@lshtm.ac.uk

Christopher Smith (co-supervisor, NU) - Christopher.Smith@lshtm.ac.uk

Brief description of project / theme

The Philippines has one of the fastest growing HIV epidemics in the world, with a 174% increase in HIV incidence between 2010 and 2017 (Gangcuangco et al. 2019). In view of this, the Government has recently committed to stepping up prevention and testing in the communities as well as care and support services for people living with HIV (COP 2018).

Yet the diversion of resources to the COVID-19 pandemic, which has resulted in more than 370,000 cases in the Philippines as of October 2020, along with social distancing policies has severely restricted the delivery of HIV programs. In Manila, for example, significant disruptions in consultations, community testing, and the supply of essential ARV have been reported (Quilantang et al. 2020).

This proposed doctoral project will focus on the impact of the COVID-19 pandemic on the provision of HIV services in the Philippines. To this end, the research design will include two main components. First, the student will conduct an observational study of medical records from one or more selected health facilities in the capital Manila to measure changes in clinical outcomes along three successive patient cohorts: pre-outbreak, pre and during outbreak, and during outbreak. The analysis will be conducted using the “care cascade”, a model that has been widely used to assess continuity and quality of HIV care (UNAIDS 2014). In keeping with the national guidelines in the Philippines (DOH 2016), HIV outcomes will include: diagnosed PLHIV, enrolled in HIV care, currently alive and on ART, tested for viral load, and virally suppressed (DOH 2016). Individual steps of the HIV cascades will be compared pre and post-COVID using test statistics, logistic regression or other methods as appropriate.

Secondly, qualitative methods will also be used to explore the experiences of people living with HIV during the pandemic and the response of health care providers to minimise disruptions. Patients in cohort 3 ('during COVID-19 outbreak') who experienced disruptions to care will be identified in consultation with clinic staff. Interviews with patients will focus on: (1) background information on access to care (eg health insurance and other payment methods; accessibility of health services); (2) the impact of disruptions due to COVID-19 on access to services in terms of service availability, quality of care, adherence to ART and associated costs; (3) actions taken to mitigate disruptions (if any); (4) concerns with COVID-19 exposure at HIV clinics. Health workers will also be interviewed to explore (1) the impact of COVID-19 on work routines; (2) the impact of COVID-19 on quality of care and ART supplies; (3) mitigating actions taken or recommended (if any); (4) concerns with COVID-19 exposure at HIV clinics; (5) concerns with increased COVID-19 susceptibility among PLHIV. The sample size will be determined by data saturation although it is estimated that about 15 patients and 15 health workers will be interviewed. Emerging themes will be identified and explored using thematic analysis, combining deductive and inductive analytical strategies.

  • COP (2018). Republic Act No. 11166. Manila: Congress of the Philippines. Available at: www.officialgazette.gov.ph/2018/12/20/republic-act-no-11166/
  • Gangcuangco LM (2019). HIV crisis in the Philippines: urgent actions needed. The Lancet Public Health 4(2): E84. DOI: 10.1016/S2468-2667(18)30265-2
  • Quilantang MIN, Bermudez ANC, Operario D (2020). Reimagining the Future of HIV Service Implementation in the Philippines Based on Lessons from COVID-19. AIDS and Behavior. 24(11):3003-3005. DOI: 10.1007/s10461-020-02934-x.
  • DOH(2016). The state of the Philippine HIV epidemic 2016. Facing challenges, forging solutions. Manila: Department of Health. Available at: https://www.doh.gov.ph/sites/default/files/publications/publication__no…
  • UNAIDS (2014). 90-90-90: an ambitious treatment target to help end the AIDS & epidemic.

The role of LSHTM and NU in this collaborative project

This project fits well with ongoing activities at both the LSHTM and NU. The lead supervisor, Marco Liverani, is currently investigator in an LSHTM-based project on the impact of COVID-19 on HIV and TB care in Indonesia. At NU, several studies on response to COVID-29 in the Philippines are also being conducted, relying on the existing partnerships and overseas research facilities and involving Christopher Smith (second supervisor). Thus, the successful candidate would have the opportunity to work in an ideal research environment to conduct this project, both in terms of supervision and access to field resources.

Particular prior educational requirements for a student undertaking this project

The successful candidate will have a postgraduate degree in a relevant subject such as health policy, epidemiology, social sciences with a focus on health (eg medical sociology, medical anthropology) or medical training.

Evidence of experience with independent and collaborative research is also desirable, as documented by involvement in peer-reviewed publications.

Skills we expect a student to develop/acquire whilst pursuing this project

The ability to design and deliver independently a complex project in health policy and systems research, involving qualitative and quantitative methods. The ability to produce high-quality academic publications based on the research findings.