The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities

ABSTRACT

Introduction

In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US.

Areas Covered

To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE.

Expert opinion

Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.

KEYWORDS:

• HIV
• care continuum
• COVID-19
• pandemic
• disruption
• innovation
• challenges
• prevention
• HIV testing
• disparities

Article highlights

• The model of the HIV Care Continuum describes a pathway from a person being diagnosed with HIV to being linked to care, to receiving and engaging in care, and ultimately achieving viral suppression (VS). It has been used to inform the United States National Ending the HIV Epidemic (EHE) initiative and holds high relevance for evaluating the impact of the COVID-19 pandemic on HIV care.

• The COVID-19 pandemic highlighted the importance of social determinants among racial/ethnic minorities, under-educated, unemployed, unstably housed, uninsured and food insecure individual. These populations faced increased barriers to receiving HIV care, especially in the setting of increased mental health symptoms and substance use disorders.

• During the COVID-19 pandemic, STI and HIV testing, PrEP refills, as well as visits for routine HIV care declined rapidly, due to reduced laboratory capacity, staff shortages, limited transportation, and clinic closures. Compared to the pre-pandemic period, lower STI and HIV testing rates, decreased PrEP visits, higher HIV positivity rates, and difficulties accessing ART medications were reported.

• In response to interruptions in care, many healthcare providers and institutions across the US adapted different modes for delivering both HIV preventive care and treatment, including distribution of home-based testing kits, PrEP, free contraceptives, as well as instituting remote consultations via telehealth, and providing ancillary social supports such as housing and food assistance.

• While the pandemic initially disrupted progress in achieving EHE, several innovative approaches to care delivery were either scaled-up, adapted, or created in response. These approaches may help further our progress toward EHE in the post-pandemic era.

• For innovative care delivery models to remain useful and to reach those most in need, it is crucial that systematic evaluations are performed regularly to assess the feasibility, acceptability, sustainability, and differential uptake of these new approaches to HIV care delivery.

Declaration of interest

AD Castel has received research funding from Gilead Sciences and has served as an advisor to Gilead Sciences as well. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.