Assessing the impact of COVID-19 on HIV outcomes in the United States

Abstract

A modeling study of the effect of COVID-19 on HIV in the United States was conducted, incorporating recent data. Analysis shows a likely decrease in 2020 to 2021 incidence but, absent additional prevention efforts, a possible increase in 2023 to 2024 incidence.BackgroundThe COVID-19 pandemic impacted sexual behaviors and the HIV continuum of care in the United States, reducing HIV testing and diagnosis, and use of preexposure prophylaxis and antiretroviral therapy. We aimed to understand the future implications of these effects through a modeling study.MethodsWe first ran our compartmental model of HIV transmission in the United States accounting for pandemic-related short-term changes in transmission behavior and HIV prevention and care provision in 2020 to 2021 only. We then ran a comparison scenario that did not apply pandemic effects but assumed a continuation of past HIV prevention and care trends. We compared results from the 2 scenarios through 2024.ResultsHIV incidence was 4 center dot 4% lower in 2020 to 2021 for the pandemic scenario compared with the no-pandemic scenario because of reduced levels of transmission behavior, despite reductions in HIV prevention and care caused by the pandemic. However, reduced care led to less viral load suppression among people with HIV in 2020, and in turn, our model resulted in a slightly greater incidence of 2 center dot 0% from 2022 to 2024 in the COVID-19 scenario, as compared with the non-COVID scenario.DiscussionDisruptions in HIV prevention and care services during COVID-19 may lead to somewhat higher postpandemic HIV incidence than assuming prepandemic trends in HIV care and prevention continued. These results underscore the importance of continuing to increase HIV prevention and care efforts in the coming years.