Makhado, L.Netshisaulu, O. P.Nkadimeng, Naledi2025-11-062025-11-062025-09-05Nkadimeng, N. 2025. The effect of COVID-19 lockdown regulations on art initiation among people living with HIV in Johannesburg, Gauteng Province, South Africa. . .https://univendspace.univen.ac.za/handle/11602/3025MPHDepartment of Public HealthBackground: The COVID-19 pandemic has profoundly impacted healthcare delivery globally, disrupting services critical to managing chronic conditions like HIV. In South Africa, the burden of HIV, combined with the pandemic's restrictions, presented unique challenges for People Living with HIV (PLHIV). Lockdown regulations, designed to curb the virus's spread, inadvertently hindered access to healthcare services, including Antiretroviral Therapy (ART) initiation. ART is vital for reducing HIV-related morbidity and mortality and achieving global goals like the UNAIDS 90-90-90 targets. This study investigates the effects of lockdown regulations on ART initiation rates in Johannesburg, highlighting the pandemic's implications for HIV management in a resource-limited setting. Objectives: The study aimed to: • Assess ART initiation rates before, during, and after COVID-19 lockdown regulations in Johannesburg's Region D, Soweto. • Examine the barriers that hindered ART initiation during the lockdown period. • Provide recommendations for healthcare policy and planning to address service disruptions during pandemics or similar crises. Methods: This quantitative study utilized a retrospective chart review design to evaluate ART initiation trends across eight healthcare facilities in Region D, Soweto. Facilities were selected using simple random sampling to ensure representativeness. Data spanning 2019 (pre-lockdown), 2020–2021 (lockdown period), and 2022 (post-lockdown) were extracted from the Department of Health’s databases (DHIS and Tier.net). A self-designed checklist captured key metrics, including demographic data and ART initiation rates. Data analysis involved descriptive and inferential statistics using SPSS Version 29, with visual presentations in charts and tables. Ethical approvals were secured from the University of Venda and relevant health authorities. Results: The findings revealed a significant decline in ART initiation rates during the COVID-19 lockdown period. Community Health Centres (CHCs) reported a 40% decrease in ART initiation compared to a 20% reduction in primary healthcare clinics. Patient retention rates during the lockdown also varied, with CHCs achieving only 55% retention compared to 75% in clinics. Key barriers identified included restricted mobility due to stringent lockdown measures, fear of exposure to COVID-19, and the reallocation of healthcare resources to pandemic management. Despite these challenges, post-lockdown recovery efforts gradually improved ART initiation and retention. Conclusions: The COVID-19 pandemic disrupted ART initiation and highlighted systemic vulnerabilities in HIV service delivery. While necessary to contain the pandemic, lockdown regulations underscored the need for resilient healthcare systems capable of maintaining essential services during crises. This study recommends leveraging technology-based solutions such as telemedicine, scaling up community-based testing, and improving healthcare resource allocation to mitigate the impact of similar disruptions in the future. Ensuring accessibility and continuity of HIV care during pandemics is critical to maintaining progress toward global HIV eradication goals. Significance of the Study: The study provides critical insights into how lockdown regulations affected ART initiation in a high-HIV-burden setting. By addressing gaps in HIV service delivery during emergencies, the findings can inform public health strategies, strengthen resilience in healthcare systems, and safeguard the health of vulnerable populations during future pandemics. Recommendations: To enhance the response to healthcare crises, it is essential to strengthen policies that prioritize vital services, ensuring that the initiation of antiretroviral therapy (ART) and overall HIV care experience minimal disruption during emergencies. In this context, expanding telemedicine services can play a crucial role by facilitating remote consultations and effective management of ART. By incorporating telehealth, healthcare providers can continue supporting patients without requiring physical visits, which is particularly important during restrictive mobility. Additionally, increasing community-based testing and treatment outreach programs will help address the challenges of lockdowns and social distancing measures. These initiatives can ensure that individuals can still access essential services without travelling long distances. It is also vital to allocate adequate resources for HIV services during emergencies. This strategic planning will prevent interruptions in care that could jeopardize the health of those living with HIV. Finally, targeted public awareness campaigns should be implemented to reduce fear and stigma surrounding HIV, promoting a proactive approach to healthcare-seeking behaviour even during pandemics. By educating communities about their options and the importance of continued care, we can foster a supportive environment that encourages individuals to seek the help they need.1 online resource (xii, 78 leaves): color illustrations, color mapsenUniversity of VendaCOVID-19UCTDHIV managementART initiationLockdown regulationsHealthcareResiliencePatient retentionDissertationNkadimeng N. The effect of COVID-19 lockdown regulations on art initiation among people living with HIV in Johannesburg, Gauteng Province, South Africa. []. , 2025 [cited yyyy month dd]. Available from:Nkadimeng, N. (2025). <i>The effect of COVI-19 lockdown regulations on art initiation among people living with HIV in Johannesburg, Gauteng Province, South Africa</i>. (). . Retrieved fromNkadimeng, Naledi. <i>"The effect of COVID-19 lockdown regulations on art initiation among people living with HIV in Johannesburg, Gauteng Province, South Africa."</i> ., , 2025.TY - Dissertation AU - Nkadimeng, Naledi AB - Background: The COVID-19 pandemic has profoundly impacted healthcare delivery globally, disrupting services critical to managing chronic conditions like HIV. In South Africa, the burden of HIV, combined with the pandemic's restrictions, presented unique challenges for People Living with HIV (PLHIV). Lockdown regulations, designed to curb the virus's spread, inadvertently hindered access to healthcare services, including Antiretroviral Therapy (ART) initiation. ART is vital for reducing HIV-related morbidity and mortality and achieving global goals like the UNAIDS 90-90-90 targets. This study investigates the effects of lockdown regulations on ART initiation rates in Johannesburg, highlighting the pandemic's implications for HIV management in a resource-limited setting. Objectives: The study aimed to: • Assess ART initiation rates before, during, and after COVID-19 lockdown regulations in Johannesburg's Region D, Soweto. • Examine the barriers that hindered ART initiation during the lockdown period. • Provide recommendations for healthcare policy and planning to address service disruptions during pandemics or similar crises. Methods: This quantitative study utilized a retrospective chart review design to evaluate ART initiation trends across eight healthcare facilities in Region D, Soweto. Facilities were selected using simple random sampling to ensure representativeness. Data spanning 2019 (pre-lockdown), 2020–2021 (lockdown period), and 2022 (post-lockdown) were extracted from the Department of Health’s databases (DHIS and Tier.net). A self-designed checklist captured key metrics, including demographic data and ART initiation rates. Data analysis involved descriptive and inferential statistics using SPSS Version 29, with visual presentations in charts and tables. Ethical approvals were secured from the University of Venda and relevant health authorities. Results: The findings revealed a significant decline in ART initiation rates during the COVID-19 lockdown period. Community Health Centres (CHCs) reported a 40% decrease in ART initiation compared to a 20% reduction in primary healthcare clinics. Patient retention rates during the lockdown also varied, with CHCs achieving only 55% retention compared to 75% in clinics. Key barriers identified included restricted mobility due to stringent lockdown measures, fear of exposure to COVID-19, and the reallocation of healthcare resources to pandemic management. Despite these challenges, post-lockdown recovery efforts gradually improved ART initiation and retention. vii Conclusions: The COVID-19 pandemic disrupted ART initiation and highlighted systemic vulnerabilities in HIV service delivery. While necessary to contain the pandemic, lockdown regulations underscored the need for resilient healthcare systems capable of maintaining essential services during crises. This study recommends leveraging technology-based solutions such as telemedicine, scaling up community-based testing, and improving healthcare resource allocation to mitigate the impact of similar disruptions in the future. Ensuring accessibility and continuity of HIV care during pandemics is critical to maintaining progress toward global HIV eradication goals. Significance of the Study: The study provides critical insights into how lockdown regulations affected ART initiation in a high-HIV-burden setting. By addressing gaps in HIV service delivery during emergencies, the findings can inform public health strategies, strengthen resilience in healthcare systems, and safeguard the health of vulnerable populations during future pandemics. Recommendations: To enhance the response to healthcare crises, it is essential to strengthen policies that prioritize vital services, ensuring that the initiation of antiretroviral therapy (ART) and overall HIV care experience minimal disruption during emergencies. In this context, expanding telemedicine services can play a crucial role by facilitating remote consultations and effective management of ART. By incorporating telehealth, healthcare providers can continue supporting patients without requiring physical visits, which is particularly important during restrictive mobility. Additionally, increasing community-based testing and treatment outreach programs will help address the challenges of lockdowns and social distancing measures. These initiatives can ensure that individuals can still access essential services without travelling long distances. It is also vital to allocate adequate resources for HIV services during emergencies. This strategic planning will prevent interruptions in care that could jeopardize the health of those living with HIV. Finally, targeted public awareness campaigns should be implemented to reduce fear and stigma surrounding HIV, promoting a proactive approach to healthcare-seeking behaviour even during pandemics. By educating communities about their options and the importance of continued care, we can foster a supportive environment that encourages individuals to seek the help they need. DA - 2025-09-05 DB - ResearchSpace DP - Univen KW - COVID-19 KW - HIV management KW - ART initiation KW - Lockdown regulations KW - Healthcare KW - Resilience KW - Patient retention LK - https://univendspace.univen.ac.za PY - 2025 T1 - The effect of covid-19 lockdown regulations on art initiation among people living with HIV in Johannesburg, Gauteng province, South Africa TI - The effect of covid-19 lockdown regulations on art initiation among people living with HIV in Johannesburg, Gauteng province, South Africa UR - ER -