IMPACT OF COVID-19 ON TRANSMISSIBLE INFECTION SCREENING AT AN URBAN SAFETY-NET HOSPITAL

ABSTRACT

BACKGROUND: Bacterial sexually transmitted infections (bSTI) and HIV outbreaks are on the rise nationally. Early diagnosis, which reduces individual and community morbidity, requires ready access to symptomatic and asymptomatic testing. The coronavirus 2019 (COVID-19) pandemic drove a shift towards telemedicine and the prioritization of symptomatic treatment over asymptomatic screening, raising concern about potential reductions in testing. The impact in safety-net settings, which faced disproportionate baseline bSTI/HIV rates rooted in structural inequities, and where many patients lacked telemedicine resources, is not yet known. This study describes the impact of COVID-19 on bSTI/HIV testing at an urban, safety-net hospital located in one of the federal Ending the HIV Epidemic priority counties. METHODS: The study took place at Boston Medical Center (BMC) in Suffolk County, MA. Medical center-wide chlamydia, gonorrhea, syphilis, and HIV testing volume and positivity rates were ed from July 1 2019-August 31 2021. On the basis of institutional modified COVID-19 operations, we defined the following study periods pre-pandemic (July 1 2019 - February 29 2020), peak-pandemic (March 1 2020 -May 31 2020), and post-peak (June 1 2020 - August 31 2021). Descriptive statistics were used to characterize testing trends. RESULTS: Testing Volume Bacterial STI and HIV test volume dropped sharply beginning in March 2020. bSTI testing peak-pandemic (mean 1,145 tests/mo) was 42% of pre-pandemic baseline (mean 2,738 tests/mo) and nadired in April 2020 (766 tests). Similarly, peak-pandemic HIV testing (mean 711 tests/mo) was 43%of pre-pandemic baseline (mean 1635 tests/mo) and nadired in April 2020 with 438 tests concentrated in inpatient and ED settings. Post-peak bSTI (mean 2,551 tests/ mo) and HIV (mean 1585 tests/mo) testing did not return to baseline until March 2021. Positivity Rate Peak-pandemic bSTI tests were 10% more likely to be positive compared to the pre-pandemic period (4.64% vs 4.10%). Gonorrhea and chlamydia tests were 13% more likely to be positive (5.64% vs 4.98%), reaching peak positivity of 7.33% in April 2020. HIV tests were 35% more likely to be positive (1.76% vs 1.30%). CONCLUSIONS: Bacterial STI and HIV testing rates at an urban safety-net hospital declined precipitously at the onset of the pandemic and did not return to baseline levels until 1 year later. Increased positivity rate further supports the inadequacy of peak-pandemic testing. Facing another winter surge in COVID-19 cases, safety-net settings should develop low-barrier alternatives to traditional office-visit based testing, including walk-in and home testing pathways to mitigate testing gaps, high positivity rates, and associated morbidity.