HIV testing, positivity rates decline during COVID-19 pandemic

A decrease in diagnostic HIV testing volume, as well as positivity and acute infections rates, has been observed during the COVID-19 pandemic, but differences exist across regions and between sexes, according to a US study presented at the 11th International AIDS Society Conference (IAS 2021).

In addition, “[s]tate-specific restrictions and SARS-CoV-2 transmission concerns may affect healthcare engagement among those at high risk for HIV infection,” the researchers said.

The study compared the volume of the HIV diagnostic test, 4th generation HIV1/2 antigen/antibody with nucleic acid confirmation, ordered in the United States and Puerto Rico from March to October 2020, to test volume ordered during the same period in 2019. Valid tests results were interpreted using guidelines set by the Centers for Disease Control and Prevention.

The researchers assessed HIV positivity and acute infection rates by geography, patient sex, and age and compared these between the two time periods using Z test for two population proportions. Two-tailed p<0.05 was deemed significant.

A 17.5-percent drop was noted in HIV diagnostic test volume from 3.36 million in the period from March to October 2020 compared to the same period in 2019. HIV positivity rates (0.677 percent to 0.662 percent; p=0.023) and the proportion of positive tests showing acute HIV infection (1.154 percent to 0.910 percent; p=0.016) also decreased. [IAS 2021, abstract PEB069]

Changes in positivity rates differed between regional and state levels, with significant declines in the Southeast (0.849 percent to 0.764 percent; p<0.0001) and South Central regions (0.948 percent to 0.889 percent; p=0.004) and a significant increase in the West (0.574 percent to 0.664 percent; p<0.0001).

Positivity rates rose in males (1.406 percent to 1.479 percent; p<0.0001), particularly those aged <25 years (0.820 percent to 0.971 percent; p<0.0001) and 25–40 years (1.504 percent to 1.600 percent; p=0.0002). Men aged 25­–40 years also showed a significant decrease in the number of positive tests showing acute infection (1.271 percent to 0.897 percent; p=0.035).

On the other hand, positivity declined in females (0.256 percent to 0.229 percent; p<0.0001), especially those aged 25–40 years (0.164 percent to 0.148 percent; p=0.003). Those aged <25 years had a significant increase in the number of positive tests that had an acute infection (2.105 percent to 5.611 percent; p=0.028).

“Patient visits to ambulatory care centres declined during the COVID-19 pandemic, which may affect HIV screening rates and hinder progress toward 90-90-90 targets,” the researchers said.

Interruptions in HIV services also occurred in Southeast Asia, particularly among populations who use drugs (adjusted odds ratio, 2.46, 95 percent confidence interval, 1.17–5.25; p=0.019). A study in Malaysia found that even before the pandemic, there had been limited access to HIV-related treatment and prevention services among individuals reporting drug use. [IAS 2021, abstract PED336]

“These results support the hypothesis that key populations who use drugs were more likely to continue to experience HIV service interruption, compared to other at-risk counterparts,” the authors said. “Therefore, findings from our study warrant innovative strategies to engage key populations who use drugs to comprehensive HIV and ancillary health services, especially amidst the pandemic.“