Impact of COVID-19 Response on the HIV Epidemic in Men Who Have Sex With Men in San Francisco County: The Importance of Rapid Return to Normalcy

Citina Liang; Sze-Chuan Suen; Anthony Nguyen; Corrina Moucheraud; Ling Hsu; Ian W Holloway; Edwin D Charlebois; Wayne T Steward

doi:10.1097/QAI.0000000000003156

Impact of COVID-19 Response on the HIV Epidemic in Men Who Have Sex With Men in San Francisco County: The Importance of Rapid Return to Normalcy

J Acquir Immune Defic Syndr. 2023 Apr 15;92(5):370-377. doi: 10.1097/QAI.0000000000003156. Epub 2022 Dec 26.

Authors

Citina Liang¹, Sze-Chuan Suen¹, Anthony Nguyen¹, Corrina Moucheraud^{2

3}, Ling Hsu⁴, Ian W Holloway^{3

5}, Edwin D Charlebois⁶, Wayne T Steward⁶

Affiliations

¹ Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California Viterbi School of Engineering, LA.
² Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, LA.
³ The Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California Los Angeles, Los Angeles, CA.
⁴ San Francisco Department of Public Health, HIV Surveillance Unit, San Francisco, CA.
⁵ Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA; and.
⁶ Department of Medicine, University of California, San Francisco, San Francisco, CA.

Abstract

Background: In response to the COVID-19 pandemic, San Francisco County (SFC) had to shift many nonemergency health care resources to COVID-19, reducing HIV control resources. We sought to quantify COVID-19 effects on HIV burden among men who have sex with men (MSM) as SFC returns to pre-COVID service levels and progresses toward the Ending the HIV Epidemic (EHE) goals.

Setting: Microsimulation model of MSM in SFC tracking HIV progression and treatment.

Methods: Scenario analysis where services affected by COVID-19 [testing, care engagement, pre-exposure prophylaxis (PrEP) uptake, and retention] return to pre-COVID levels by the end of 2022 or 2025, compared against a counterfactual where COVID-19 changes never occurred. We also examined scenarios where resources are prioritized to reach new patients or retain of existing patients from 2023 to 2025 before all services return to pre-COVID levels.

Results: The annual number of MSM prescribed PrEP, newly acquired HIV, newly diagnosed, and achieving viral load suppression (VLS) rebound quickly after HIV care returns to pre-COVID levels. However, COVID-19 service disruptions result in measurable reductions in cumulative PrEP use, VLS person-years, incidence, and an increase in deaths over the 2020-2035 period. The burden is statistically significantly larger if these effects end in 2025 instead of 2022. Prioritizing HIV care/prevention initiation over retention results in more person-years of PrEP but less VLS person-years and more deaths, influencing EHE PrEP outcomes.

Conclusions: Earlier HIV care return to pre-COVID levels results in lower cumulative HIV burdens. Resource prioritization decisions may differentially affect different EHE goals.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

COVID-19* / epidemiology
HIV Infections* / drug therapy
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Male
Pandemics
Pre-Exposure Prophylaxis* / methods
San Francisco / epidemiology
Sexual and Gender Minorities*

Abstract

Publication types

MeSH terms

Grants and funding