Yue Zhang, Brenna C Hogan, Kelly A Gebo, Peter F Rebeiro, Milton L Wainberg, Catherine R Lesko, Vincent C Marconi, N Sarita Shah, Raynell Lang, Nel Jason L Haw, Yawei Cheng, Michael A Horberg, Jennifer O Lam, Michael J Silverberg, George Yendewa, Joseph J Eron, Richard D Moore, Angela M Parcesepe, Keri N Althoff, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
HIV care encounters returned to prepandemic levels by late 2020, with sustained viral suppression. Prolonged COVID-19 restrictions were associated with higher risk of unsuppressed VL. HIV patients, providers, and clinics showed resilience during COVID-19 disruptions, offering lessons for future emergencies.
BACKGROUND: Temporary COVID-19-related restrictions disrupted routine HIV care and viral load (VL) testing for people with HIV (PWH). Whether and when encounters and VL suppression returned to prepandemic levels remains unclear. We aimed to evaluate changes in HIV clinical encounter frequency and VL suppression from 2018 through 2021, and assess the impact of COVID-19 restriction policy.
METHODS: Adults (≥18 years) with HIV from 12 US clinical cohorts with ≥1 VL test from June 2020 to December 2021 were categorized into mutually exclusive HIV care groups: (1) in-care before restrictions, (2) new-to-care, and (3) re-engaging during restrictions. Logistic regression with generalized estimating equations was used to estimate adjusted odds ratios (aOR) of unsuppressed VL (>200 copies/mL) for HIV care groups from June 2020 to December 2021. A linear mixed model evaluated associations between state-level COVID-19 policy strength (mild, moderate, or strong) and unsuppressed VL.
RESULTS: Among PWH in-care (n = 48 605), encounter frequency decreased sharply during early COVID-19 restrictions but returned to prepandemic levels by December 2020, and suppressed VL rate remained above 91%. New-to-care (n = 105) or re-engaging (n = 483) individuals did not increase odds of unsuppressed VL (vs in-care, aOR = 0.91 [95% CI: 0.73, 1.13]). Those living in states with strong (vs mild, aOR = 1.31 [0.93, 1.86]) COVID-19 restriction policies had increased odds of unsuppressed VL, though not significant.
CONCLUSIONS: HIV care encounters returned to prepandemic levels by late 2020, with sustained viral suppression. Prolonged COVID-19 restrictions were associated with higher risk of unsuppressed VL. HIV patients, providers, and clinics showed resilience during COVID-19 disruptions, offering lessons for future emergencies.