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IntroductionThe COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services.MethodsWe used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics.ResultsMaintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19-146 discounted deaths per 10,000 clients.DiscussionWhile there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

PURPOSE:To determine whether visual-tactile sensory substitution utilizing the Low-vision Enhancement Optoelectronic (LEO) Belt prototype is suitable as a new visual aid for those with reduced peripheral vision by assessing mobility performance and user opinions. METHODS:Sighted subjects (n = 20) and subjects with retinitis pigmentosa (RP) (n = 6) were recruited. The LEO Belt was evaluated on two cohorts: normally sighted subjects wearing goggles to artificially reduce peripheral vision to simulate stages of RP progression, and subjects with advanced visual field limitation from RP. Mobility speed and accuracy was assessed using simple mazes, with and without the LEO Belt, to determine its usefulness across disease severities and lighting conditions. RESULTS:Sighted subjects wearing most narrowed field goggles simulating most advanced RP had increased mobility accuracy (44% mean reduction in errors, p = 0.014) and self-reported confidence (77% mean increase, p = 0.004) when using the LEO Belt. Additionally, use of LEO doubled mobility accuracy for RP subjects with remaining visual fields between 10° and 20°. Further, in dim lighting, confidence scores for this group also doubled. By patient reported outcomes, subjects largely deemed the device comfortable (100%), easy to use (92.3%) and thought it had potential future benefit as a visual aid (96.2%). However, regardless of severity of vision loss or simulated vision loss, all subjects were slower to complete the mazes using the device. CONCLUSIONS:The LEO Belt improves mobility accuracy and therefore confidence in those with severely restricted peripheral vision. The LEO Belt's positive user feedback suggests it has potential to become the next generation of visual aid for visually impaired individuals. Given the novelty of this approach, we expect navigation speeds may improve with experience.