HIV Services and Outcomes During the COVID-19 Pandemic - United States, 2019-2021

Abstract

Increasing HIV testing, preexposure prophylaxis (PrEP), and antiretroviral therapy (ART) are pillars of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative, with a goal of decreasing new HIV infections by 90% by 2030.* In response to the COVID-19 pandemic, a national emergency was declared in the United States on March 13, 2020, resulting in the closure of nonessential businesses and most nonemergency health care venues; stay-at-home orders also limited movement within communities (1). As unemployment increased during the pandemic (2), many persons lost employer-sponsored health insurance (3). HIV testing and PrEP prescriptions declined early in the COVID-19 pandemic (4-6); however, the full impact of the pandemic on use of HIV prevention and care services and HIV outcomes is not known. To assess changes in these measures during 2019-2021, quarterly data from two large U.S. commercial laboratories, the IQVIA Real World Data - Longitudinal Prescription Database (IQVIA),^† and the National HIV Surveillance System (NHSS)^§ were analyzed. During quarter 1 (Q1)^¶ 2020, a total of 2,471,614 HIV tests were performed, 190,955 persons were prescribed PrEP, and 8,438 persons received a diagnosis of HIV infection. Decreases were observed during quarter 2 (Q2), with 1,682,578 HIV tests performed (32% decrease), 179,280 persons prescribed PrEP (6% decrease), and 6,228 persons receiving an HIV diagnosis (26% decrease). Partial rebounds were observed during quarter 3 (Q3), with 2,325,554 HIV tests performed, 184,320 persons prescribed PrEP, and 7,905 persons receiving an HIV diagnosis. The proportion of persons linked to HIV care, the number who were prescribed ART, and proportion with a suppressed viral load test (<200 copies of HIV RNA per mL) among those tested were stable during the study period. During public health emergencies, delivery of HIV services outside of traditional clinical settings or that use nonclinical delivery models are needed to facilitate access to HIV testing, ART, and PrEP, as well as to support adherence to ART and PrEP medications.

FIGURE

Change in the number of HIV tests (A), percentage change in the number of HIV tests from quarter to quarter (B), change in the number of persons prescribed preexposure prophylaxis (C), and percentage change in the number of persons prescribed preexposure prophylaxis from quarter to quarter (D), by age group — United States 2019–2021 Abbreviations: PrEP = preexposure prophylaxis; Q1 = quarter 1; Q2 = quarter 2; Q3 = quarter 3; Q4 = quarter 4. * Commercial laboratory HIV antigen/antibody testing data from LabCorp and Quest Diagnostics, 2019–2021. Because data were incomplete for January 2019, the Q1–Q2 change was not calculated. ^† The percentage change in the number of HIV tests from Q1 2020 to Q2 2020 was larger among persons aged ≥35 years (−38.6%; 95% CI = −38.8 to −38.4) compared with persons aged 15–24 years (−25.7%; 95% CI = −26.0 to −25.4) and 25–34 years (−27.2%; 95% CI = −27.4 to −27.0). ^§ IQVIA Real World Data — Longitudinal Prescription Database, 2019–2021. ^¶ The percentage change in the number of persons prescribed PrEP from Q1 2020 to Q2 2020 was larger among persons aged 15–24 years (−8.9%; 95% CI = −10.8 to −6.9) compared with persons aged 25–34 years (−7.8%; 95% CI = −8.7 to −6.8) and ≥35 years (−4.4%; 95% CI = −5.2 to −3.5).