Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study.

BACKGROUND: Non-emergent clinical services were limited or suspended during the early stages of the coronavirus disease 2019 (COVID-19) pandemic in the United States (U.S.). This could adversely impact epidemics of public health importance, such as HIV, and access to testing, which is a cornerstone of prevention efforts. METHODS: In this observational study, we collected HIV testing and positivity rate clinical data from four geographically diverse U.S. healthcare systems in New Orleans, Louisiana; Minneapolis, Minnesota; Providence, Rhode Island; and, Seattle, Washington. Data from 2019 to 2020 were examined to assess changes in HIV testing in community-based, emergency department, and outpatient settings. Poisson regression was used to explore trends in HIV testing through phases of the COVID-19 pandemic. FINDINGS: In outpatient settings, there was a 68-97% reduction in the number of HIV tests per week during each state's stay-at-home order period, compared to during the pre-stay-at-home order period in early 2020. HIV testing remained reduced 11-54% after states transitioned to advisory phases. The HIV positivity rate increased slightly at outpatient settings, except in New Orleans where it fell. INTERPRETATION: We found a concerning trend of substantially decreased HIV testing across four geographically diverse sites. These findings suggest that new HIV infections within the U.S. may be undiagnosed and not yet linked to clinical care and services, as a consequence of the COVID-19 pandemic. Thus, augmented efforts to identify patients and link them to HIV services will be needed as healthcare settings return to full operation. FUNDING: U.S. National Institute of Mental Health.

Visit Trends and Factors Associated With Telemedicine Uptake Among Persons With HIV During the COVID-19 Pandemic.

BACKGROUND: In response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, clinicians in outpatient HIV practices began to routinely offer telemedicine (video and/or phone visits) to replace in-person appointments. Video visits are preferred over phone visits, but determinants of video visit uptake in HIV care settings have not been well described. METHODS: Trends in type of encounter (face-to-face, video, and phone) before and during the pandemic were reviewed for persons with HIV (PWH) at an urban, academic, outpatient HIV clinic in Seattle, Washington. Logistic regression was used to assess factors associated with video visit use including sociodemographic characteristics (age, race, ethnicity, language, insurance status, housing status) and electronic patient portal login. RESULTS: After an initial increase in video visits to 30% of all completed encounters, the proportion declined and plateaued at ~10%. A substantial proportion of face-to-face visits were replaced by phone visits (~50% of all visits were by phone early in the pandemic, now stable at 10%-20%). Logistic regression demonstrated that older age (>50 or >65 years old compared with 18-35 years old), Black, Asian, or Pacific Islander race (compared with White race), and Medicaid insurance (compared with private insurance) were significantly associated with never completing a video visit, whereas history of patient portal login was significantly associated with completing a video visit. CONCLUSIONS: Since the pandemic began, an unexpectedly high proportion of telemedicine visits have been by phone instead of video. Several social determinants of health and patient portal usage are associated with video visit uptake.

Advancing Digital Health Equity: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revolutionized the practice of ambulatory medicine, triggering rapid dissemination of digital healthcare modalities, including synchronous video visits. However, social determinants of health, such as age, race, income, and others, predict readiness for telemedicine and individuals who are not able to connect virtually may become lost to care. This is particularly relevant to the practice of infectious diseases (ID) and human immunodeficiency virus (HIV) medicine, as we care for high proportions of individuals whose health outcomes are affected by such factors. Furthermore, delivering high-quality clinical care in ID and HIV practice necessitates discussion of sensitive topics, which is challenging over video without proper preparation. We describe the "digital divide," emphasize the relevance to ID and HIV practice, underscore the need to study the issue and develop interventions to mitigate its impact, and provide suggestions for optimizing telemedicine in ID and HIV clinics.

The Impact of COVID-19 on HIV Care Provided via Telemedicine-Past, Present, and Future.

PURPOSE OF REVIEW: This review summarizes HIV care delivered via telemedicine before and during the COVID-19 pandemic and highlights areas of study to inform optimal usage of telemedicine in HIV clinical practice in the future. RECENT FINDINGS: To address barriers to care created by the COVID-19 pandemic, regulatory agencies and payors waived longstanding restrictions, which enabled rapid expansion of telemedicine across the country. Preliminary data show that providers and persons with HIV (PWH) view telemedicine favorably. Some data suggest telemedicine has facilitated retention in care, but other studies have found increasing numbers of PWH lost to follow-up and worsened virologic suppression rates despite offering video and/or telephone visits. The COVID-19 pandemic has exacerbated gaps in the HIV care continuum. To help mitigate the impact, most clinics have adopted new virtual care options and are now evaluating usage, impact, and concerns. Further research into the effects of telemedicine on HIV care and continued work towards universal access are needed.