COVID-19 and disruptions in HIV prevention: Projecting the impact on HIV incidence

The COVID-19 pandemic has disrupted many aspects of the health care system, including access to HIV prevention services. As the U.S. observes National HIV Testing Day on June 27, Science Speaks reached out to William C. Goedel, PhD, an assistant professor in the Department of Epidemiology at the Brown University School of Public Health, who authored a study recently published in Open Forum Infectious Diseases. The study projected the effects of these disruptions — and how they might be mitigated — among a population that faced a high burden of the HIV epidemic in this country even before COVID-19. Dr. Goedel responded to several questions about the research over email.

What motivated or prompted you and your co-authors to look at this topic and in this way?

Since 2018, our team has been collaborating on a prospective cohort study of gay, bisexual and other men who have sex with men who are newly initiating pre-exposure prophylaxis at three clinical sites across the country to better understand what the patient experience of using PrEP is like — what brings people into PrEP care, how long do they stay in PrEP care and why do they leave PrEP care when they do. When the COVID-19 pandemic began, we immediately saw disruptions to our own ability to provide the typical range of clinical services we usually do and in our patients’ abilities to maintain their engagement in care. We had concerns that, because these disruptions impacted entire communities’ abilities to access to HIV testing and other important services, this could lead to increases in new HIV infections over time.

We decided to use TITAN, a type of mathematical model called an agent-based network model, to project what might happen under different circumstances. Mathematical models allow us to simulate a range of different scenarios to approximate what’s happening in the real world and project what could happen if we were to make different decisions, so we thought this approach was most useful for helping us see, first, what might happen as a result of severe disruptions in access to HIV prevention services and, more importantly, what we might be able to do to mitigate these disruptions.

What are the main takeaways from your findings?

We found that, assuming access to HIV testing and other HIV prevention services like PrEP continues to be reduced as a result of the COVID-19 pandemic and the associated strain on the health care system, HIV incidence may increase relative to what we might have seen if these disruptions did not happen. Importantly, we found that, if we can return to pre-pandemic levels of service provision, we can reverse these increases and put ourselves back on track towards our goals of ending the HIV epidemic in the United States.

What does this study add to what’s currently known about the effects of disruptions to HIV prevention services, particularly HIV testing, during the pandemic?

This is an additional study that helps us understand the potential magnitude of increases in HIV incidence that are possible with continued disruptions to HIV prevention services during the COVID-19 pandemic. Importantly, we are one of the first studies to examine these impacts among Black/African American gay, bisexual and other men who have sex with men in the Southeastern United States, a population that faced a high burden of the HIV epidemic in the United States prior to the COVID-19 pandemic and significant barriers to routinely accessing HIV prevention services.

How can disruptions like these be prevented or mitigated in the future? Are there ways to limit their effects in this setting?

Identifying alternative methods for people to access these crucial services in emergency settings is crucial. Telemedicine (along with self-collected lab specimens) offers an important opportunity to maintain access to HIV prevention services when in-person clinical operations are limited. Of course, this assumes that everyone has easy access to the kinds of technologies needed to complete a telemedicine appointment, so we need to take additional steps to make sure every person can benefit from these innovations in care delivery.

Read the full study, “Projected Effects of Disruptions to HIV Prevention Services During the COVID-19 Pandemic Among Black/African American Men Who Have Sex With Men in an Ending the HIV Epidemic Priority Jurisdiction,” on the OFID website.