Modelling the impact of covid-19-related disruptions on hiv in the United States

ABSTRACT

Background: During the COVID-19 pandemic, gay, bisexual and other men who have sex with men (MSM) in the United States (US) have reported similar or fewer sexual partners and reduced access to HIV testing and care. Pre-exposure prophylaxis (PrEP) use has declined. We estimated the potential impact of COVID-19 on HIV incidence and HIV-related mortality among US MSM. Methods: We used a calibrated HIV transmission model for MSM in Baltimore, Maryland, and available data on COVID-19-related disruptions (from national online surveys of US MSM and from a Boston clinic with extensive PrEP experience) to predict impacts of data-driven reductions in sexual partners (0% or 25% - based on different surveys), condom use (5%), HIV testing (20%), viral suppression (VS;10%), PrEP initiations (72%), PrEP use (9%) and ART initiations (50%), exploring different disruption durations. We estimated the median (95% credible interval) relative change in cumulative new HIV infections and HIV-related deaths among MSM over 1 and 5 years from the start of COVID- 19-related disruptions, compared with a scenario without COVID-19-related disruptions. Results: A 6-month 25% reduction in sexual partners among Baltimore MSM, without HIV service changes, could reduce new HIV infections by 12 2%(11 7,12 8%) and 3 0%(2 6,3 4%) over 1 and 5 years, respectively. In the absence of changes in sexual behaviour, the 6-month data-driven disruptions to condom use, testing, VS, PrEP initiations, PrEP use and ART initiations combined were predicted to increase new HIV infections by 10 5%(5 8,16 5%) over 1 year, and by 3 5%(2 1,5 4%) over 5 years. A 25% reduction in partnerships offsets the negative impact of these combined service disruptions on new HIV infections (overall reduction 3 9%(-1 0,7 4%) and 0 0%(-1 4,0 9%) over 1 and 5 years, respectively), but not on HIV-related deaths (corresponding increases 11 0%(6 2,17 7%), 2 6%(1 5,4 3%)). Of the different service disruptions, a 6-month 10% reduction in VS was predicted to have the greatest impact, increasing new infections by 6 4%(2 6,11 9%) and HIV-related deaths by 9 5%(5 2,15 9%) over 1 year, without changes in sexual behaviour. The predicted impacts of reductions in partnerships or VS doubled if they lasted 12 months or if disruptions were twice as large. Conclusion: Maintaining access to ART and adherence support is of the utmost importance to minimise excess HIV-related mortality due to COVID-19 restrictions in the US, even if accompanied by reductions in sexual partnerships.