Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Public Health Analytic Consulting Services, Inc., Hillsborough, NC.
J Acquir Immune Defic Syndr. 2022 Oct 1;91(2):117-121. doi: 10.1097/QAI.0000000000003049.
Organizations offering HIV prevention services have reported interruptions during the COVID-19 pandemic. The national extent of these interruptions and their public health impact remain largely unexplored.
Using data from 60 state and local health departments, we compared HIV testing services outcomes in calendar years 2019 and 2020, including the number of Centers for Disease Control and Prevention (CDC)-funded HIV tests conducted, the percentage of persons with newly diagnosed HIV infection (ie, HIV positivity), and the percentage linked to HIV medical care within 30 days after new diagnoses (ie, linkage to care) using χ2 and robust Poisson models. We also assessed the independent associations between the pandemic period (ie, March-December 2020) and the number of COVID-19 cases with monthly HIV testing services outcomes using multivariable robust Poisson models.
There was a 46.0% (P < 0.001) reduction in the number of CDC-funded HIV tests conducted in 2020 (n = 1,255,895) compared with 2019 (n = 2,324,421). Although there were fewer persons with newly diagnosed HIV in 2020 (n = 5581 vs. n = 7739 in 2019), HIV positivity was greater in 2020 (0.4% vs. 0.3% in 2019; adjusted prevalence ratio [aPR] = 1.33, 95% confidence interval [CI]: 1.05 to 1.69). When adjusting for the monthly number of COVID-19 cases, the pandemic period was associated with a 56% reduction in the number of monthly CDC-funded HIV tests (adjusted rate ratio = 0.44, 95% CI: 0.37 to 0.52) but 28% higher monthly HIV positivity (aPR = 1.28 95% CI: 1.16 to 1.41) and 10% higher linkage to care (aPR = 1.10, 95% CI: 1.02 to 1.18).
Despite increased HIV positivity, a drastic reduction in the number of CDC-funded HIV tests was observed in 2020, affecting the ability to identify persons with newly diagnosed HIV. CDC and health departments will need to expand testing strategies to cover tests not conducted in 2020 while adapting to the continuing pandemic.A visual abstract is available for this article at: http://links.lww.com/QAI/B941.
提供艾滋病毒预防服务的组织在新冠疫情期间报告了服务中断。这些中断的全国范围及其对公共卫生的影响在很大程度上仍未得到探索。
我们使用来自 60 个州和地方卫生部门的数据，比较了 2019 年和 2020 年的艾滋病毒检测服务结果，包括美国疾病控制与预防中心（CDC）资助的艾滋病毒检测数量、新诊断出艾滋病毒感染的人数百分比（即 HIV 阳性率），以及新诊断后 30 天内与艾滋病毒医疗保健相关联的人数百分比（即，与护理相关联），使用 χ2 和稳健泊松模型。我们还使用多变量稳健泊松模型评估了大流行期间（即 2020 年 3 月至 12 月）与每月艾滋病毒检测服务结果之间的独立关联与每月 COVID-19 病例数。
与 2019 年（n = 2324421）相比，2020 年 CDC 资助的艾滋病毒检测数量减少了 46.0%（P < 0.001）（n = 1255895）。尽管 2020 年新诊断出的艾滋病毒感染者人数较少（n = 5581 与 2019 年的 n = 7739），但 2020 年 HIV 阳性率更高（0.4%与 2019 年的 0.3%；调整后患病率比[aPR] = 1.33，95%置信区间[CI]：1.05 至 1.69）。在调整每月 COVID-19 病例数后，大流行期间与每月 CDC 资助的 HIV 检测数量减少 56%相关（调整后的比率 = 0.44，95%CI：0.37 至 0.52），但每月 HIV 阳性率增加 28%（aPR = 1.28，95%CI：1.16 至 1.41），并增加 10%的治疗关联（aPR = 1.10，95%CI：1.02 至 1.18）。
尽管 HIV 阳性率有所增加，但 2020 年 CDC 资助的艾滋病毒检测数量大幅减少，这影响了识别新诊断出的艾滋病毒感染者的能力。疾病预防控制中心和卫生部门将需要扩大检测策略，以涵盖 2020 年未进行的检测，同时适应持续的大流行。本文有一个可视化摘要可在以下网址查看：http://links.lww.com/QAI/B941。
