COVID-19-RELATED DISRUPTIONS in the HIV CARE CONTINUUM in A LARGE URBAN COHORT of PWH

ABSTRACT

Background: COVID-19 has caused severe disruptions in healthcare access. The impact on persons with HIV (PWH), including their outcomes along the HIV care continuum is still being assessed. Washington, DC is a hotspot for both HIV and COVID-19 infections. We sought to describe the impact of COVID-19 on the care continuum among a cohort of PWH enrolled in a longitudinal HIV study, the DC Cohort. Methods: DC Cohort participants enrolled by 09/1/2018 and active as of 3/1/2020 were included in the analysis (N=8,274). Using cross-sectional and longitudinal approaches, we assessed engagement in care (EIC) (i.e., at least one viral load [VL], CD4 or visit), receipt of cART, and viral suppression (VS)(i.e., VL<200 copies/ml) during the pre-pandemic era (3/1/2019-3/1/2020) versus the recent peri-pandemic era (9/1/2020-9/1/2021) using Cohort data. A subset of participant data was linked to a cross-sectional COVID-19 survey (N=801). Uni-and bivariate analysis were used to describe care continuum outcomes and factors associated with care disruption. Results: Among 8,274 participants, engagement in care during the pre (71.0%) vs peri pandemic (62.5%) era declined significantly (p<.0001). The proportion of participants who were on cART during each era was stable (90.9% vs 90.8% respectively, p=0.1131). 70.3% of participants achieved VS in the pre pandemic era vs 61.2% in the peri-pandemic era (p<.0001). Longitudinally, 9.5% of participants were no longer EIC peri-pandemic;2.4% of participants were no longer on cART peri-pandemic, 6.5% had a loss of VS and 7.3% had no labs in the peri-pandemic era. Among the subset of participants completing the survey, there were no significant differences between those who maintained VS versus those who did not/had no labs in demographics, employment, changes in income, insurance or housing, or self-reported ability to access non-HIV related care or telehealth. Most surveyed participants reported no change in their ability to fill ARV prescriptions (86%) or daily ARV adherence (89%);however, 20% and 13% reported decreased ability to make and keep HIV appointments, respectively, and 15% reported decreased ability to get laboratory examinations completed. Conclusion: Our analysis shows that COVID-19 has disrupted HIV care continuum outcomes including EIC, ART, and loss of viral suppression. As the pandemic continues, efforts to engage PWH through telehealth, multi-month dispensing, and home-based testing, are needed to ensure continued progress towards ending the HIV epidemic.