Abstract and Introduction
Background: Organizations offering HIV prevention services have reported interruptions during the COVID-19 pandemic. The national extent of these interruptions and their public health impact remain largely unexplored.
Methods: Using data from 60 state and local health departments, we compared HIV testing services outcomes in calendar years 2019 and 2020, including the number of Centers for Disease Control and Prevention (CDC)-funded HIV tests conducted, the percentage of persons with newly diagnosed HIV infection (ie, HIV positivity), and the percentage linked to HIV medical care within 30 days after new diagnoses (ie, linkage to care) using χ 2 and robust Poisson models. We also assessed the independent associations between the pandemic period (ie, March—December 2020) and the number of COVID-19 cases with monthly HIV testing services outcomes using multivariable robust Poisson models.
Results: There was a 46.0% (P < 0.001) reduction in the number of CDC-funded HIV tests conducted in 2020 (n = 1,255,895) compared with 2019 (n = 2,324,421). Although there were fewer persons with newly diagnosed HIV in 2020 (n = 5581 vs. n = 7739 in 2019), HIV positivity was greater in 2020 (0.4% vs. 0.3% in 2019; adjusted prevalence ratio [aPR] = 1.33, 95% confidence interval [CI]: 1.05 to 1.69). When adjusting for the monthly number of COVID-19 cases, the pandemic period was associated with a 56% reduction in the number of monthly CDC-funded HIV tests (adjusted rate ratio = 0.44, 95% CI: 0.37 to 0.52) but 28% higher monthly HIV positivity (aPR = 1.28 95% CI: 1.16 to 1.41) and 10% higher linkage to care (aPR = 1.10, 95% CI: 1.02 to 1.18).
Discussion: Despite increased HIV positivity, a drastic reduction in the number of CDC-funded HIV tests was observed in 2020, affecting the ability to identify persons with newly diagnosed HIV. CDC and health departments will need to expand testing strategies to cover tests not conducted in 2020 while adapting to the continuing pandemic.
A visual abstract is available for this article at: https://links.lww.com/QAI/B941
In the United States, the Centers for Disease Control and Prevention (CDC) funds state and local health departments, community-based organizations, and other partners to conduct HIV prevention services, surveillance, and demonstration projects. HIV prevention services consist of activities to increase individual knowledge of HIV status and reduce HIV acquisition and transmission. Such activities include HIV testing, linkage to HIV medical care, and referral to and provision of essential support services. These activities play an important role in the Ending the HIV Epidemic in the U.S. (EHE) initiative.[2,3] However, many organizations offering HIV prevention services have reported interruptions in their capacity to provide these services during the COVID-19 pandemic.
During the March 23–June 7, 2020 stay-at-home order, the New York City Department of Health and Mental Hygiene found that reported positive tests for HIV declined markedly in March 2020, reached a low point in April 2020, and rebounded slowly beginning in May 2020. Compared with the same period in 2019, there was a 59% reduction in the number of new HIV diagnoses in 2020.
To better understand the extent to which these interruptions in HIV prevention services have occurred in the United States and the impact on the annual performance of CDC-funded HIV programs, we describe the changes in annual CDC-funded HIV testing and testing services outcomes experienced by health departments in 2020 compared with 2019. We also assess associations between the pandemic period (ie, March—December 2020) and monthly COVID-19 cases with monthly CDC-funded HIV tests or testing services outcomes.
J Acquir Immune Defic Syndr. 2022;91(2):117-121. © 2022 Lippincott Williams & Wilkins