ABSTRACT
Background: The potential impact of COVID-19 pandemic on the US HIV epidemic remains unclear. Characterizing the scope and main drivers of the impact of COVID-19 on HIV incidence can inform future HIV policy. Methods: We characterized the impact of COVID-19 pandemic and attendant lockdowns on HIV epidemiology via reductions in sexual transmission (0-50%) from March 1st, 2020 to July 4th, 2021, plus reductions in viral suppression (0-40%), HIV testing (0-50%), and pre-exposure prophylaxis use (0-30%) from March 1st to February 4th, 2022. Using the Johns Hopkins Epidemiologic and Economic Model (JHEEM) of HIV transmission, we projected HIV infections from 2020 to 2025 across 32 high-priority US cities and compared these to projections if COVID-19 had not emerged. Results: Across all 32 cities, 80% of simulations projected a decline in HIV incidence in 2020 (median decrease of 15% from 2019), before rebounding in 2021 (96% of simulations, median increase of 13% from 2020)-see Figure, panel B. Projections of the impact of the COVID-19 pandemic on cumulative HIV incidence from 2020-2025 varied by city, ranging from a median of 3% fewer incident cases in Las Vegas to 9% more incident cases in Boston (Figure, panel A). At the MSA level, reductions in sexual transmission had the strongest impact on incidence, followed by reductions in viral suppression. Among simulations that incorporated large (>25%) reductions in viral suppression due to COVID-19, adverse impacts on HIV incidence were greater where pre-pandemic levels of viral suppression were higher (ranging from a median 1% increase in cumulative incidence 2020-25 in Chicago with 52% pre-pandemic suppression, to a 24% increase in Seattle with 86% pre-pandemic suppression-Figure, panel C). Conclusion: The effects of COVID-19 on HIV transmission remain uncertain and differ substantially at the local level. Disruptions to HIV care and viral suppression due to the COVID-19 pandemic may have greater impact in increasing HIV incidence in settings where pre-existing suppression levels are higher.