National Testing Assessment of Select Bacterial STIs During the COVID-19 Pandemic

Background. Chlamydia, gonorrhea, and syphilis infections rose in the US for 6 consecutive years before the COVID-19 pandemic. Patterns of sexually transmitted infection (STI) testing during the COVID-19 pandemic have yet to be fully assessed. Methods. We performed a retrospective study of STI testing in the Veteran's Health Administration (VHA) healthcare system during each calendar year 2019-2021 using electronic health record data. We determined the number of chlamydia (CT) and gonorrhea (GC), and syphilis tests performed overall and in demographic groups defined by age, birth sex, self-reported race, region, and HIV status. Results. VHA performed 202,503 CT tests, 201,314 GC tests and 250,790 syphilis tests in 2019, followed by a 23% and 25% decrease in 2020 for CT/GC and syphilis testing, respectively. We observed decreases among all subgroups defined by age, sex, race, and geography. Race groups with the biggest decreases in 2020 include Asian Americans (-28%) and Hawaiian and Pacific Islanders (-27%). By 2021, overall testing rates demonstrated a partial recovery to 89.8% of their 2019 levels. Testing rates in 2021 in rural/ highly rural residents remained 17% below baseline, compared with 10% for urban dwellers. Veterans living in the Northeast, South, or Midwest had the least recovery among geographic regions (16%, 11% and 11% below baseline, respectively). People with HIV experienced a decline in CT/GC testing of 15% but by the end of 2021 this had recovered to 1.9% below baseline. Women experienced both a steeper drop and a smaller recovery in CT and GC testing relative to men Conclusion. After dramatic reductions in STI testing during the COVID-19 pandemic, rates returned to near-baseline levels nationally by 2021. Testing rates have lagged in some patient groups, most notably rural and highly rural populations, women, and Black and Asian American Veterans, placing them at risk for disparities in STI diagnosis, and therefore treatment. Testing rates in Veterans under age 25 years have reached or exceeded pre-pandemic levels. (Figure Presented).

HYPERTENSION CARE CASCADE during COVID in VETERANS with HIV

Background: People with HIV (PWH) are at an increased risk of atherosclerotic cardiovascular disease (ASCVD) compared with those without HIV. Hypertension (HTN) is an important modifiable risk factor for ASCVD, yet HTN management in PWH is suboptimal. The HTN care cascade provides a valuable framework for evaluating HTN care quality. We use data from the Veterans Health Administration (VHA), the single largest U.S. provider of HIV care, to describe HTN care in a nationwide cohort of PWH. We sought to define the HTN care cascade in two years to identify gaps in care and assess impact of the COVID-19 pandemic. Methods: VHA databases were queried to identify Veterans with HIV in care in calendar year (CY) 2019 and 2020. For each CY, we identified cascade steps for HTN care: HTN diagnosis was defined using patient problem lists and validated ICD-10 and SNOMED code-associated outpatient encounters;HTN treatment was defined as active prescription of 1+ antihypertensive drugs;HTN monitoring required at least 2 recorded blood pressure (BP) readings at least 90 days apart;lastly, HTN control was defined as having a last BP recording less 140/90. We compared the care cascade across 2 years to identify potential COVID-19 related changes in HTN care quality. We calculated descriptive statistics using medians and percentages and CY comparisons using Chi-square tests. Results: We identified 31,465 veterans with HIV in the VHA in CY20, 48% were Black, 35% White, 6% self-identified as Hispanic, majority were men (96%) with a median age of 64 years (range 23-96), median body mass index of 27.7 (range 13-74) with 16.5% of Veterans living in rural or highly rural areas. There were no demographic differences between CY19 or 20. In CY19, 12,625 (40%) PWH had a HTN diagnosis, similar to that of CY20 (12,561;39%). Of these, similar proportions were on treatment for HTN in CY19 (87%) compared to CY20 (88%). Among those on treatment, more patients were monitored (59% vs. 54%;p<0.0001, CI 3.4-6) and of these, more were controlled (59% vs. 54%;p=0.0001, CI 1.8-5.4) for HTN in CY19 compared with CY20. Of all the PWH with a diagnosis of HTN, more were monitored in CY19 (59% vs. 52%;p<0.0001) and had controlled HTN compared with CY20 (67% vs 57%;p<0.0001, CI 8.5-10.9). Conclusion: This nationwide HTN cascade reveals gaps in HTN monitoring and control for Veterans with HIV. The COVID-19 pandemic likely further adversely impacted HTN care delivery in this population.