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IMPACT of the COVID-19 PANDEMIC on HIV OUTPATIENT CARE and VIRAL SUPPRESSION in NYC
Topics in Antiviral Medicine ; 30(1 SUPPL):381, 2022.
Article in English | EMBASE | ID: covidwho-1880088
ABSTRACT

Background:

The COVID-19 pandemic has had significant impacts on the healthcare system, including HIV outpatient care. Lockdowns, infection concerns, and staffing and resource shortages had the potential to affect patient care and viral suppression.

Methods:

We conducted a retrospective analysis of patients at six HIV primary care clinics in New York City in the Mount Sinai Health system. We compared outcomes in a pre-COVID period [PC], Mar 2019-Feb 2020, to a COVID period [CP] of Mar 2020-Feb 2021. Demographics of interest included age, sex, race/ethnicity, and HIV risk factor. In the two time periods we compared viral load suppression (VLS;HIV RNA <200 copies/mL), primary care encounters, antiretroviral (ART) prescribing, and hospitalizations. We then evaluated predictors of loss of VLS or loss to follow-up in a logistic regression model.

Results:

Our cohort was comprised of 9,740 HIV primary care patients with ≥1 viral load measurement PC. Median age was 53 years and 79% were male;20% were white, 37% Black, and 30% Hispanic. 42% had an HIV risk factor of MSM, 22% heterosexual sex, and 4% injection drug use (IDU). 87.9% (8559/9740) of the PWH during PC had VLS. While 90.7% (7268/8013) of the population assessed during CP had VLS, 18% of the initial cohort had no VL testing during this period and 15% had neither testing nor a clinical visit during CP. In CP, 13% had at least one measured detectable HIV VL (≥200 copies/mL). Primary care encounters decreased from 93% to 79%. ART prescription rates were unchanged 88% had active prescriptions for >80% of the year both PC and in CP. All-cause hospitalizations decreased from 766 (7.9%) to 633 (6.5%;p<.001). Male sex (OR 1.32,CI 1.17-1.49), identification as a transgender woman (OR 1.81,CI 1.22-2.69), age <35 years (OR 1.74,CI 1.53-1.97), Black race (OR 1.4,CI 1.23-1.59), and HIV risk factor of heterosexual sex (OR 1.54,CI 1.34-1.77) and IDU (OR 1.73,CI 1.35-2.22) were associated with loss of VLS or loss to follow-up.

Conclusion:

In this large cohort of PWH in a NYC medical system, viral suppression of those who remained in care remained stable-yet a substantial portion of patients were not engaged in care and monitored for VLS during the CP. Strategies to retain patients in care and ensure suppression (eg, with televisits and care coordination) may have helped mitigate effects of the pandemic. Clinics must continue targeted efforts to re-engage patients, facilitate access to testing, and prevent longstanding loss to follow-up in at-risk groups.
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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Topics in Antiviral Medicine Year: 2022 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Topics in Antiviral Medicine Year: 2022 Document Type: Article