Impact of COVID-19 on HIV service delivery in Miami-Dade County: a mixed methods study

Abstract

Background Facilitating access to HIV prevention and treatment is imperative in Miami-Dade County (MDC), a U.S. HIV epicenter. With COVID-19, disruptions to these services have occurred, leading HIV organizations to innovate and demonstrate resilience. This study documented COVID-19 related disruptions and resilient innovations in HIV services within MDC. Methods This mixed methods cross-sectional study included HIV test counselors in MDC. In the quantitative component (N=106), participants reported COVID-19 impacts on HIV service delivery. Data visualization examined patterns within organizations and throughout the study period. Generalized estimating equation modeling examined differences in service disruptions and innovations. In the qualitative component, participants (N=20) completed interviews regarding COVID-19 impacts on HIV services. Rapid qualitative analysis was employed to analyze interviews. Results Quantitative data showed that innovations generally matched or outpaced disruptions, demonstrating resilience on HIV service delivery during COVID-19. HIV testing (36%, 95%CI[28%, 46%]) and STI testing (42%, 95%CI[33%, 52%]) were most likely to be disrupted. Sexual/reproductive health (45%, 95%CI[35%, 55%]), HIV testing (57%, 95%CI[47%,66%]), HIV case management (51%, 95%CI[41%, 60%]), PrEP initiation (47%, 95%CI[37%,57%]), and STI testing (47%, 95%CI[37%, 57%]) were most likely to be innovated. Qualitative analysis revealed three orthogonal themes related to 1) disruptions (with five sub-components), 2) resilient innovations (with four sub-components), and 3) emerging and ongoing health disparities. Conclusions HIV organizations faced service disruptions during COVID-19 while also meaningfully innovating. Our findings point to potential changes in policy and practice that could be maintained beyond the immediate impacts of COVID-19 to enhance the resilience of HIV services. Aligning with the US Ending the HIV Epidemic Plan and the National Strategy for HIV/AIDS, capitalizing on the observed innovations would facilitate improved HIV-related health services for people living in MDC and beyond.

Syndemic effect of COVID-19 outbreak on HIV care delivery around the globe: A systematic review using narrative synthesis

“…Despite of considerable heterogeneity of settings and services, 14 out of the 31 included studies (45%) reported decreased testing or reduced lab monitoring during the COVID-19 pandemic resulting in delay in diagnosis. 15 , 22 , 25 , 26 , 28 , 29 , 33 , 35 …”

“…The decrease in traditional facility-based clinic appointments were compensated by virtual telemedicine platforms. 9 , 12 , 15 , 18 , 22 , 23 , 25 , 26 , 28 , 37 Sustainable strategies like home delivery of ART medications, 15 , 30 multi-month dispensing of ART for stable PLHIVs, 13 , 22 provision of HIV self-testing to know one’s sero-status 14 , 20 , 33 has been reported. A study conducted by Parikh et al in Indian setting, reported nutritional supplementation and door-to-door ration delivery along with ART.…”

“…Although a meta-analysis was not possible due to a lack of quantitative summary from the available literature, this review has tried to summarize the repercussions of the coronavirus pandemic on HIV comprehensive care services under six major themes and has been discussed using a framework (Figure 5). Results revealed that the majority of the studies reported decreased testing or reduced lab monitoring, 15,22,25,26,28,29,33,35 ultimately leading to a delay in diagnosis and hence interrupting the treatment cascade. 9,11,18,29,31,33 It has been found that few countries have adopted multi-month dispensing of drugs 8,13,22,32 while most of the countries could not, due to a shortage of drugs.…”

Collaborative PrEP Implementation Strategies for Latino Men Who have Sex with Men: A Health Center-Community Consensus Process

“…Quest, LabCorp) that may be more conveniently located than health centers [33,34]. Such low-barrier strategies are effective for increasing PrEP engagement [35][36][37] and have been increasingly adopted in the setting of the COVID-19 pandemic [38,39]. Importantly, both content experts and focus group participants indicated that these strategies would work for some but not all clients, and emphasized a need for tailored approaches that offer individual choice-findings that are consistent with the limited literature supporting individualized approaches to improve PrEP engagement among LMSM [31,32].…”