The impact of COVID-19 pandemic on the dynamic HIV care engagement among people with HIV: real-world evidence

Abstract

Introduction: Existing studies examining the impact of the COVID-19 pandemic on engagement in HIV care often capture cross-sectional status, while lacking longitudinal evaluations. This study examined the impact of the pandemic on the longitudinal dynamic change of retention in care and viral suppression status. Methods: The electronic health record (EHR) data of this population-level cohort study were retrieved from the statewide electronic HIV/AIDS reporting system in South Carolina. The study population was people with HIV (PWH) who had at least one year's symmetric follow-up observation record before and after the pandemic. Multivariable generalized linear mixed regression models were employed to analyze the impact of the pandemic on these outcomes, adjusting for socio-demographic characteristics and preexisting comorbidities. Results: In the adjusted models, PWH had a lower likelihood of retention in care (adjusted odds ratio [aOR]: 0.806, 95% confidence interval [CI]: 0.769, 0.844) and a higher probability of virological failure (aOR: 1.240, 95% CI: 1.169, 1.316) during the peri-pandemic period than pre-pandemic period. Results from interaction effect analysis from each cohort revealed that the negative effect of the pandemic on retention in care was more severe among PWH with high comorbidity burden than those without any comorbidity; meanwhile, a more striking virological failure was observed among PWH who reside in urban areas than in rural areas. Conclusion: The COVID-19 pandemic has a negative impact on retention in care and viral suppression among PWH in South Carolina, particularly for individuals with comorbidities and residing in urban areas.

Progress in Eliminating Perinatal HIV Transmission in the Metropolitan DC Area Between 2018-2022

“…33 In South Carolina, there was a lower likelihood of retention in care and a higher probability of virologic failure during the pandemic compared with the prepandemic period. 34 Pregnant women also experienced disruptions in accessing prenatal care in the United States through reduced frequency of visits with provider or patient cancellation to avoid the risk of potential COVID-19 exposure and providers discussing health impacts of COVID-19 rather than pregnancy. 35 Navigating pregnancy can be complicated, especially when living with HIV in the middle of a pandemic.…”