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

Hoover, Karen W.; Zhu, Weiming; Gant, Zanetta; Delaney, Kevin P.; Wiener, Jeffrey; Carnes, Neal; Thomas, Dominique; Weiser, John; Huang, Ya-Lin; Cheever, Laura W.; Kourtis, Athena P.

doi:10.15585/mmwr.mm7148a1

Cited by 33 publications

(30 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although testing rates appeared stable, the total number of tests performed decreased. This finding in consistent with recent work demonstrated decreased HIV testing during the early 2020 period [9]. Decreased testing could imply that the median time from infection to diagnosis has increased compared with prepandemic estimates.…”

Section: Discussionsupporting

confidence: 91%

“…This can result in increased HIV transmission in the community and an increased proportion of late HIV diagnoses. Although persons with HIV had ongoing access to care and antiretroviral medication and the proportion with a suppressed viral load remained stable [9], it is critical the HIV prevention safety net be supported during times of decreased healthcare access such as a public health emergency.…”

Section: Discussionmentioning

confidence: 99%

“…Despite Centers for Disease Control and Prevention (CDC) recommendations for routine opt-out and risk-based HIV testing without counseling and consent [5], rates of HIV testing in emergency departments have been historically low including during the years preceding the EHE launch in 2019 [1,3,6]. In early 2020, the COVID-19 pandemic decreased access to preventive care and screening, including HIV testing, especially in emergency departments with an observed large drop in emergency department visit volumes [7][8][9]. Additionally, already limited emergency department resources -staffing, time, and space -were further constrained and prioritized for care of COVID-19 patients [10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Estimates of HIV testing at visits to United States emergency departments

Clay,

Hoover,

Le Guen

et al. 2023

Aids

Self Cite

View full text Add to dashboard Cite

Objectives: Emergency department (ED)-based HIV testing rates are historically low, but recent testing trends surrounding the COVID-19 pandemic and launch of the Ending the HIV Epidemic (EHE) initiative are unknown. The objective of the study is to estimate recent trends in the proportion of ED visits that included HIV testing. Methods: We performed a cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted nationally representative survey of US EDs, from 2014 to 2020. Given EHE's focus on several rural Southern jurisdictions as well as populations disproportionately affected by HIV, we stratified by characteristics including US region and visit-listed race and ethnicity. Results: The proportion of ED visits that included HIV testing increased from 2014 (0.6%) to 2018 (1.1%) but was lower in 2019 and 2020 (0.8%). Compared to other regions the South had the lowest rates of testing in both 2019 (0.6%) and 2020 (0.5%); testing rates in the non-metropolitan South remained ≤0.1% across all years. Testing rates for ED visits by persons who identified as Hispanic/Latino were highest in 2018 (2.2%) but were sharply lower in 2019 and 2020 (0.8%). Conclusion: After a small but insufficient increase in ED-based HIV testing since 2014, rates decreased between 2018 and 2019 and were stable between 2019 and 2020. Overall, very few ED visits during our entire study period included an HIV test and there were persistently low rates of HIV testing for populations prioritized in national efforts and during visits in rural jurisdictions in the South.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Estimates of HIV testing at visits to United States emergency departments

Clay,

Hoover,

Le Guen

et al. 2023

Aids

Self Cite

View full text Add to dashboard Cite

show abstract

“…telePrEP) during the COVID-19 epidemic [15,16]. Such a nontraditional clinical model may help those in a PrEP desert to access PrEP services [17]. Mail-in tests and telePrEP not only improve access to services or reduce providers' becoming 'burned out' but also can reduce stigma for receiving PrEP services [18,19].…”

Section: Introductionmentioning

confidence: 99%

Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

Kamitani

Mizuno

DeLuca

et al. 2023

Aids

View full text Add to dashboard Cite

Objectives: To identify types, evidence, and study gaps of alternative HIV preexposure prophylaxis (PrEP) care delivery models in the published literature. Design: Systematic review and narrative synthesis. Methods: We searched in the US Centers for Disease Control and Prevention (CDC) Prevention Research Synthesis (PRS) database through December 2022 (PROSPERO CRD42022311747). We included studies published in English that reported implementation of alternative PrEP care delivery models. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using the adapted Newcastle-Ottawa Quality Assessment Scale. Those that met our study criteria were evaluated for efficacy against CDC Evidence-Based Intervention (EBI) or Evidence-Informed Intervention (EI) criteria or Health Resources and Services Administration Emergency Strategy (ES) criteria, or for applicability by using an assessment based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: This review identified 16 studies published between 2018 and 2022 that implemented alternative prescriber (n = 8), alternative setting for care (n = 4), alternative setting for laboratory screening (n = 1), or a combination of the above (n = 3) . The majority of studies were US-based (n = 12) with low risk of bias (n = 11). None of the identified studies met EBI, EI, or ES criteria. Promising applicability was found for pharmacists prescribers, telePrEP, and mail-in testing. Conclusions: Delivery of PrEP services outside of the traditional care system by expanding providers of PrEP care (e.g. pharmacist prescribers), as well as the settings of PrEP care (i.e. telePrEP) and laboratory screening (i.e. mail-in testing) may increase PrEP access and care delivery.

show abstract

“…8,17,18 Many of these pandemic difficulties may adversely affect engagement with pre-exposure prophylaxis (PrEP). [19][20][21] The barriers to health care access described, including a loss of insurance and broad socioeconomic difficulties, may directly prevent BSMM accessing PrEP or create undue complexities in navigating it. 22,23 In addition, many BSMM access PrEP through community-based services that often rely on strong social networks; these networks may be weakened given the increased distancing and isolation presented by the pandemic.…”

Section: Introductionmentioning

confidence: 99%

COVID-19, Vaccine Hesitancy, and HIV Pre-exposure Prophylaxis Among Black Sexual Minority Men

Turpin,

Mandell,

Camp

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Background: The Covid-19 pandemic has created substantial and profound barriers to several forms of healthcare engagement. For Black sexual minority men, this may include engagement with pre-exposure prophylaxis (PrEP) to prevent HIV infection, with significant implications for HIV disparities. Our study explored how the Covid-19 pandemic affected Black sexual minority men, with a focus on relationships between Covid-19 and PrEP engagement. Setting: We sampled 24 Black sexual minority men attending HIV prevention-related events in the greater D.C. Metropolitan area (D.C., Maryland, Virginia). Methods: We conducted qualitative phone interviews among our sample. Questions were primarily focused on the Covid-19 pandemic and how it affected engagement and considerations of PrEP use. Interviews were transcribed and qualitatively analyzed using the six stages of thematic analysis. Results: We identified three major themes from our thematic analysis: Changes in the healthcare system, changes in sexual and relationship contexts, and Covid-19 vaccine hesitancy and misinformation. Relationships between Covid-19 vaccine hesitancy and PrEP hesitancy were especially prevalent, with participants describing that Covid-19 hesitancy can directly deter PrEP use through eroding medical trust further. Conclusion: We identified changes in the healthcare system, sexual and relationship contexts, and Covid-19 vaccine hesitancy as important issues driven by Covid-19 with significant implications for PrEP use. The Covid-19 pandemic has changed the healthcare and social landscape in profound ways that impact PrEP access, sexual networks, and associated HIV vulnerability. Future research further exploring relationships between specific pandemic stressors and HIV prevention among Black sexual minority men is recommended.

show abstract

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

Cited by 33 publications

References 10 publications

Estimates of HIV testing at visits to United States emergency departments

Estimates of HIV testing at visits to United States emergency departments

Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

COVID-19, Vaccine Hesitancy, and HIV Pre-exposure Prophylaxis Among Black Sexual Minority Men

Contact Info

Product

Resources

About