HIV Prevention, Care Showed Resilience During the COVID Pandemic

Drops in HIV testing and pre-exposure prophylaxis (PrEP) prescriptions early on in the pandemic quickly stabilized by the third quarter of 2020, according to a CDC report.

The number of HIV tests performed nationally exceeded 2.4 million in the first quarter of 2020 and was reduced by 32% in the second quarter — with the arrival of the COVID-19 pandemic — before jumping back up to over 2.3 million in the year’s third quarter. Similarly, the number of people prescribed PrEP dipped by 6% from the first to second quarter of 2020 and started to rebound by the third quarter.

A 26% decrease in people diagnosed with HIV was seen in the second quarter of 2020 before starting to rebound in the third quarter as well, which study authors Karen Hoover, MD, epidemiologist of the CDC in Atlanta, and colleagues said might be attributable to decreases in testing but also potentially HIV transmission.

They acknowledged that testing and PrEP prescriptions did not reach pre-pandemic levels until early 2021. However, “the proportion of people linked to care after they received an HIV diagnosis — and the proportion of people with HIV with a suppressed viral load — both remained stable,” they reported in Morbidity and Mortality Weekly Report.

Among those tested, the proportion of patients linked to care ranged from 88.0% to 89.4% from 2019 to 2020, while those with a suppressed viral load ranged from 86.7% to 88.9% during the study period.

Early-pandemic falloffs in testing and PrEP “were likely due to disruptions to in-person clinic services and redeployment of public health staff to respond to COVID-19,” the CDC said in a press release. “A rapid rebound in services, however, is a testament to quick, resourceful local innovations that, if scaled up and sustained, could help reach national HIV prevention goals.”

The investigators attributed the stabilization in HIV care to the launching of new and expanded telehealth services, self-testing, and other programs. In particular, the availability of telehealth and home delivery likely contributed to the steady number of antiretroviral therapy prescriptions through 2019 and 2020.

“The HIV prevention and care service system was resilient during the COVID-19 pandemic,” Hoover and colleagues concluded, stressing that “HIV testing and PrEP provision using self-test kits and nonclinical delivery models are needed to ensure robust prevention services during public health emergencies.”

Their steadfast numbers were published on December 1 to coincide with World AIDS Day.

“Today, the world celebrates the dedication, resilience, and creativity of people with HIV and their public health and clinical allies who refused to let a new pandemic stand in the way of ending a longstanding one. It is just this type of resolve that, when paired with resources, will enable the nation to weather public health emergencies and prevent HIV at the same time,” said Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, in a statement.

Data for the study had been captured from two large U.S. commercial laboratories, the IQVIA Real World Data-Longitudinal Prescription Database, and the National HIV Surveillance System.

Subgroup analysis suggested that young people age 15-24 years had an especially pronounced 9% decrease in PrEP prescriptions between the first and second quarters of 2020, Hoover’s team reported.

Meanwhile, adults age 35 and up had a 39% drop in HIV tests, which was more pronounced than in the overall general population.

The CDC researchers cautioned that although their data captured more than half of laboratory tests in the U.S., the numbers of HIV antigen, antibody, and viral load tests may not be nationally representative. Moreover, tests may have been performed in duplicate and included more than once in the databases, and viral suppression estimates did not include people that did not access care.