Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California Viterbi School of Engineering, LA.
Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, LA.
J Acquir Immune Defic Syndr. 2023 Apr 15;92(5):370-377. doi: 10.1097/QAI.0000000000003156. Epub 2022 Dec 26.
In response to the COVID-19 pandemic, San Francisco County (SFC) had to shift many nonemergency health care resources to COVID-19, reducing HIV control resources. We sought to quantify COVID-19 effects on HIV burden among men who have sex with men (MSM) as SFC returns to pre-COVID service levels and progresses toward the Ending the HIV Epidemic (EHE) goals.
Microsimulation model of MSM in SFC tracking HIV progression and treatment.
Scenario analysis where services affected by COVID-19 [testing, care engagement, pre-exposure prophylaxis (PrEP) uptake, and retention] return to pre-COVID levels by the end of 2022 or 2025, compared against a counterfactual where COVID-19 changes never occurred. We also examined scenarios where resources are prioritized to reach new patients or retain of existing patients from 2023 to 2025 before all services return to pre-COVID levels.
The annual number of MSM prescribed PrEP, newly acquired HIV, newly diagnosed, and achieving viral load suppression (VLS) rebound quickly after HIV care returns to pre-COVID levels. However, COVID-19 service disruptions result in measurable reductions in cumulative PrEP use, VLS person-years, incidence, and an increase in deaths over the 2020-2035 period. The burden is statistically significantly larger if these effects end in 2025 instead of 2022. Prioritizing HIV care/prevention initiation over retention results in more person-years of PrEP but less VLS person-years and more deaths, influencing EHE PrEP outcomes.
Earlier HIV care return to pre-COVID levels results in lower cumulative HIV burdens. Resource prioritization decisions may differentially affect different EHE goals.
为应对 COVID-19 大流行，旧金山市县（SFC）不得不将许多非紧急医疗资源转移到 COVID-19，从而减少了 HIV 防控资源。我们试图量化 COVID-19 对男男性行为者（MSM）中 HIV 负担的影响，因为 SFC 正在恢复到 COVID-19 之前的服务水平，并朝着终结艾滋病流行（EHE）目标迈进。
监测 SFC 中 HIV 进展和治疗的 MSM 微观模拟模型。
通过情景分析，比较 2022 年底或 2025 年底之前受 COVID-19 影响的服务（检测、护理参与、暴露前预防（PrEP）的采用和保留）恢复到 COVID-19 之前的水平，与 COVID-19 从未发生过的情况相比。我们还研究了在 2023 年至 2025 年期间，在所有服务恢复到 COVID-19 之前，资源优先用于新患者或保留现有患者的情况。
在 HIV 护理恢复到 COVID-19 之前的水平后，每年接受 PrEP 治疗的 MSM 人数、新感染 HIV、新诊断和实现病毒载量抑制（VLS）的人数迅速增加。然而，COVID-19 服务中断导致 PrEP 累计使用量、VLS 人年数、发病率以及在 2020-2035 年期间死亡人数的显著减少。如果这些影响在 2025 年而不是 2022 年结束，那么负担会更大。优先考虑 HIV 护理/预防的启动而不是保留，会导致更多的 PrEP 人年数，但更少的 VLS 人年数和更多的死亡人数，从而影响 EHE PrEP 目标的实现。
更早地将 HIV 护理恢复到 COVID-19 之前的水平，可降低 HIV 负担的累积。资源优先决策可能会对不同的 EHE 目标产生不同的影响。
