The impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China

Abstract

Introduction: The COVID-19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV-related mortality. We estimated how COVID-19-related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China, over a one- and five-year time horizon.

Methods: Regional data from China indicated that the number of MSM undergoing facility-based HIV testing reduced by 59% during the COVID-19 pandemic, alongside reductions in ART initiation (34%), numbers of all sexual partners (62%) and consistency of condom use (25%), but initial data indicated no change in viral suppression. A mathematical model of HIV transmission/treatment among MSM was used to estimate the impact of disruptions on HIV infections/HIV-related deaths. Disruption scenarios were assessed for their individual and combined impact over one and five years for 3/4/6-month disruption periods, starting from 1 January 2020.

Results: Our model predicted new HIV infections and HIV-related deaths would be increased most by disruptions to viral suppression, with 25% reductions (25% virally suppressed MSM stop taking ART) for a three-month period increasing HIV infections by 5% to 14% over one year and deaths by 7% to 12%. Observed reductions in condom use increased HIV infections by 5% to 14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility HIV testing and ART initiation, but reduced partner numbers resulted in 11% to 23% fewer infections and 0.4% to 1.0% fewer deaths. Longer disruption periods (4/6 months) amplified the impact of disruption scenarios. When realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections occurred over one year (3% to 17%), but not for five years (1% increase to 4% decrease), whereas deaths mostly increased over one year (1% to 2%) and five years (1.2 increase to 0.3 decrease).

Conclusions: The overall impact of COVID-19 on new HIV infections and HIV-related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID-19-related disruption on HIV transmission and control among MSM in China.

Keywords: COVID-19 pandemic; HIV transmission; People’s Republic of China; key and vulnerable populations; men who have sex with men; modelling.

Figure 1

The percentage change in (a) new HIV infections and (b) HIV‐related deaths under disruption scenarios evaluated over a one‐ and five‐year time horizon (blue and orange respectively) in four cities in China. Bars indicate median values, while error bars show the 95% credible intervals for each scenario and time horizon. Scenarios are as follows: (A) Reduction in facility‐based HIV testing (59%), (B) Reduction in ART initiation (34%), (C) Reduction in number of sexual partnerships (31% to 62%), (D) reduction in condom use (12.5% to 25%) E10) Reduction in viral suppression of 10%, E25) Reduction in viral suppression of 25%.

Figure 2

The percentage change in new HIV infections and HIV‐related deaths for scenarios (a) A + B + C + D and (b) A + B + C + D + E25 for varying disruption periods (3, 4 and 6 months) and time horizons (one‐ and five‐year) in four cities in China. Dots indicate median values.

Figure 3

The percentage change in new HIV infections and HIV‐related deaths for scenario A + B + C + D for different cities (Guangzhou, Shenzhen, Jinan and Qingdao), and time horizons (one‐ and five‐year). Bars indicate median values and error bars show the 95% credible intervals.