Impact of covid-19 on hiv prevention and care indicators in san francisco, ca

ABSTRACT

Background: The COVID-19 pandemic has resulted in disruptions to HIV prevention and care services access throughout the US. We sought to evaluate the impact of service disruption from the COVID-19 pandemic response on key Getting to Zero San Francisco (GTZSF) HIV prevention and care metrics of HIV antibody (Ab) and HIV viral load (VL) testing, Pre-exposure prophylaxis (PrEP) use, and the continuum of HIV care. Methods: Reports of positive and negative HIV Ab testing from 4 laboratories and a large community testing site (CTS), and HIV VL testing for people living with HIV reported to the San Francisco Department of Public Health were included. We compared the number of HIV Ab and VL tests, and PrEP visits at the CTS each month from January-October 2020 with the corresponding months in 2019. The continuum of HIV care was calculated for new HIV diagnoses in January-June 2020 compared to the same period in 2019. Results: From January-October 2020, the mean number of monthly laboratorybased HIV Ab tests decreased from 4,400/month in 2019 to 3,644/month in 2020 (Table);and from 1,382/month to 766/month at the CTS. April 2020 had the lowest number of HIV tests, a reduction of 54% in laboratory reporting and 88% in the CTS compared with April 2019;there was a partial rebound through October 2020. While the number of positive HIV tests was lower per month in 2020 compared with 2019, the proportion HIV positive remained stable throughout the study period (2020 Range 0.9-1.4%;2019 Range 1.1-1.6%). HIV VL testing also declined in 2020 similar to the trend of HIV testing with the largest decline (57%) in April 2020. Overall, PrEP visits at the CTS declined more than 31% in the study period;the largest decline (90%) occurred in April 2020 with partial rebound through October 2020. From January to June 2020, 75 new HIV diagnoses were identified, compared with 101 in 2019. Linkage to care within 1 month was 93% in 2020 and 97% in 2019;HIV viral suppression within 6 months was 75% in 2020 and 76% in 2019. Conclusion: We have observed substantial reductions in HIV Ab and VL testing during the COVID-19 pandemic, and likely decreased HIV case finding. PrEP care engagement also declined dramatically;however rapid linkage to care and viral suppression after HIV diagnosis remained robust. Continued monitoring of key HIV prevention and care metrics is essential to assessing the complex impact of COVID-19 on the GTZSF goals, and developing tailored mitigation responses.