Impacts of COVID-19 on sexual behaviors, HIV prevention and care among men who have sex with men: A comparison of New York City and Metropolitan Atlanta

Goodreau, Steven M.; Delaney, Kevin P.; Zhu, Weiming; Smith, Dawn K.; Mann, Laura M.; Sanchez, Travis; Hamilton, Deven T.; Hoover, Karen W.

doi:10.1371/journal.pone.0282503

Cited by 6 publications

(1 citation statement)

References 35 publications

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“…Prior work examining the populationlevel scale-up of HIV interventions across six cities estimated that overall expenditures would peak in 2024 if scale-up began in 2020 [4]. COVID-19 lockdowns resulted in service disruptions, compounding already suboptimal HIV testing rates [5][6][7], and reducing the use of pre-exposure prophylaxis (PrEP) in some settings [5,6,8]. Furthermore, initial gains from evidence-based biomedical interventions to prevent, diagnose and treat HIV have slowed, as efforts to expand uptake face both structural and implementation barriers [9,10].…”

Section: Introductionmentioning

confidence: 99%

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Enns,

Sui,

Guerra‐Alejos

et al. 2024

J Int AIDS Soc.

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IntroductionImproving the delivery of existing evidence‐based interventions to prevent and diagnose HIV is key to Ending the HIV Epidemic in the United States. Structural barriers in the access and delivery of related health services require municipal or state‐level policy changes; however, suboptimal implementation can be addressed directly through interventions designed to improve the reach, effectiveness, adoption or maintenance of available interventions. Our objective was to estimate the cost‐effectiveness and potential epidemiological impact of six real‐world implementation interventions designed to address these barriers and increase the scale of delivery of interventions for HIV testing and pre‐exposure prophylaxis (PrEP) in three US metropolitan areas.MethodsWe used a dynamic HIV transmission model calibrated to replicate HIV microepidemics in Atlanta, Los Angeles (LA) and Miami. We identified six implementation interventions designed to improve HIV testing uptake (“Academic detailing for HIV testing,” “CyBER/testing,” “All About Me”) and PrEP uptake/persistence (“Project SLIP,” “PrEPmate,” “PrEP patient navigation”). Our comparator scenario reflected a scale‐up of interventions with no additional efforts to mitigate implementation and structural barriers. We accounted for potential heterogeneity in population‐level effectiveness across jurisdictions. We sustained implementation interventions over a 10‐year period and evaluated HIV acquisitions averted, costs, quality‐adjusted life years and incremental cost‐effectiveness ratios over a 20‐year time horizon (2023–2042).ResultsAcross jurisdictions, implementation interventions to improve the scale of HIV testing were most cost‐effective in Atlanta and LA (CyBER/testing cost‐saving and All About Me cost‐effective), while interventions for PrEP were most cost‐effective in Miami (two of three were cost‐saving). We estimated that the most impactful HIV testing intervention, CyBER/testing, was projected to avert 111 (95% credible interval: 110–111), 230 (228–233) and 101 (101–103) acquisitions over 20 years in Atlanta, LA and Miami, respectively. The most impactful implementation intervention to improve PrEP engagement, PrEPmate, averted an estimated 936 (929–943), 860 (853–867) and 2152 (2127–2178) acquisitions over 20 years, in Atlanta, LA and Miami, respectively.ConclusionsOur results highlight the potential impact of interventions to enhance the implementation of existing evidence‐based interventions for the prevention and diagnosis of HIV.

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Section: Introductionmentioning

confidence: 99%

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Enns,

Sui,

Guerra‐Alejos

et al. 2024

J Int AIDS Soc.

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Assessing the Impact of COVID-19 on HIV Outcomes in the United States: A Modeling Study

Viguerie,

Jacobson,

Hicks

et al. 2024

Sexual Trans Dis

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Background The COVID-19 pandemic impacted sexual behaviors and the HIV continuum-of-care in the United States, reducing HIV testing and diagnosis, and use of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART). We aim to understand the future implications of these effects through a modeling study. Methods We first ran our compartmental model of HIV transmission in the US accounting for pandemic-related short-term changes in transmission behavior and HIV prevention and care provision in 2020-2021 only. We then ran a comparison scenario that did not apply pandemic effects but assumed a continuation of past HIV prevention and care trends. We compared results from the two scenarios through 2024. Results HIV incidence was 4·4% lower in 2020-21 for the pandemic scenario compared with the no-pandemic scenario due to reduced levels of transmission behavior, despite reductions in HIV prevention and care caused by the pandemic. However, reduced care led to less viral load suppression among people with HIV (PWH) in 2020 and, in turn, our model resulted in a slightly greater incidence of 2·0% from 2022-24 in the COVID-19 scenario, as compared to the non-COVID scenario. Discussion Disruptions in HIV prevention and care services during COVID-19 may lead to somewhat higher post-pandemic HIV incidence, than assuming pre-pandemic trends in HIV care and prevention continued. These results underscore the importance of continuing to increase HIV prevention and care efforts in the coming years.

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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

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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.

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Impacts of COVID-19 on sexual behaviors, HIV prevention and care among men who have sex with men: A comparison of New York City and Metropolitan Atlanta

Cited by 6 publications

References 35 publications

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Assessing the Impact of COVID-19 on HIV Outcomes in the United States: A Modeling Study

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

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