Estimating the potential impact of COVID-19-related disruptions on HIV incidence and mortality among men who have sex with men in the United States: a modelling study

Abstract

Background: During the COVID-19 pandemic, gay and other men who have sex with men (MSM) in the United States (US) report similar or fewer sexual partners and reduced HIV testing and care access. Pre-exposure prophylaxis (PrEP) use has declined. We estimated the potential impact of COVID-19 on HIV incidence and mortality among US MSM. Methods: We used a calibrated HIV transmission model for MSM in Baltimore, Maryland, and available data on COVID-19-related disruptions to predict impacts of data-driven reductions in sexual partners(0%,25%,50%), condom use(5%), HIV testing(20%), viral suppression(10%), PrEP initiations(72%), PrEP use(9%) and ART initiations(50%) exploring different disruption durations and magnitudes. We estimated the median (95% credible interval) change in cumulative new HIV infections and deaths among MSM over one and five years, compared with a scenario without COVID-19-related disruptions. Findings: A six-month 25% reduction in sexual partners among Baltimore MSM, without HIV service changes, could reduce new HIV infections by 12.2%(11.7,12.8%) and 3.0%(2.6,3.4%) over one and five years, respectively. In the absence of changes in sexual behaviour, the six-month data-driven disruptions to condom use, testing, viral suppression, PrEP initiations, PrEP use and ART initiations combined were predicted to increase new HIV infections by 10.5%(5.8,16.5%) over one year, and by 3.5%(2.1,5.4%) over five years. A 25% reduction in partnerships offsets the negative impact of these combined service disruptions on new HIV infections (overall reduction 3.9%(-1.0,7.4%), 0.0%(-1.4,0.9%) over one, five years, respectively), but not on HIV deaths (corresponding increases 11.0%(6.2,17.7%), 2.6%(1.5,4.3%)). The predicted impacts of reductions in partnerships or viral suppression doubled if they lasted 12 months or if disruptions were twice as large. Interpretation: Maintaining access to ART and adherence support is of the utmost importance to minimise excess HIV-related mortality due to COVID-19 restrictions in the US, even if accompanied by reductions in sexual partnerships.

Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries

“…30,33 One recent study found that even with reductions in sexual partnerships, COVID-19 restrictions would result in excess HIV-related mortality without adequate access to care. 33…”

Impact of COVID-19 pandemic and anti-pandemic measures on tuberculosis, viral hepatitis, HIV/AIDS and malaria – a systematic review

“…Further details about the search results and "near misses" are in S1 section 4. We found seven modelling studies for TB [26][27][28][29][30][31][32], ten for HIV [31,[33][34][35][36][37][38][39][40][41], three for hepatitis [42][43][44] and seven for malaria [31,41,[45][46][47][48][49]. The main risk-of-bias concern was the missing uncertainty analysis, which was the case for several modelling studies.…”

“…Increase in prevalent infections, incident HCV, incident HCC and liver related deaths over 10 years (623000, 121000, 44800, 72300)WHO region [ref. ]Global[30] AMR[39] /[40] Global (LMIC)[47] EUR[42] (United Kingdom)Type of disruptiondrop in detected cases and in detected cases treated successfully Reduced viral suppression** / reduced ART retention** Artemisinin-based therapies** (children) / Households protection (ITN or IRS)** (mothers) COVID-19 infection + service change For full results, see S1 Tables 10(TB), 11(viral hepatitis), 15-17(malaria), 22(HIV). M= months, EC = excess cases, ED=excess deaths, ITN = insecticide-treated nets, SMC= seasonal malaria chemoprevention, RR=relative risk, LMIC=low-middle income countries, ART =anti-retroviral treatment, AFR = African Region, AMR = Region of Americas, EUR = European Region, WPR = Western Pacific Region.…”

Rapid, application-based survey to characterise the impacts of COVID-19 on LGBTQ+ communities around the world: an observational study

“…This also has major implications for rates of HIV transmission throughout the duration of the crisis, where changes in income and employment have been shown to increase HIV risk 57 58. Furthermore, while this analysis did not examine the impact of COVID-19 on those living with HIV, it’s been shown that interruptions to the HIV care continuum may have impacts on community transmission, treatment, and mortality 59–62. Unless efforts are undertaken to address these disparities in access to methods of prevention, decades of progress may be lost.…”