HIV Testing Before and During the COVID-19 Pandemic — United States, 2019–2020

Elizabeth A. DiNenno, PhD1; Kevin P. Delaney, PhD1; Marc A. Pitasi, MPH1; Robin MacGowan, MPH1; Gillian Miles, MPH1; Andre Dailey, MSPH1; Cari Courtenay-Quirk, PhD1; Kathy Byrd, MD1; Dominique Thomas, MPA1; John T. Brooks, MD1; Demetre Daskalakis, MD1; Nicoline Collins, MPH1 (View writer affiliations)

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Summary

What is already identified about this subject?

HIV testing is step one in accessing HIV prevention and care companies. The COVID-19 pandemic disrupted well being care supply and might need affected HIV testing, which is crucial to ending the HIV epidemic within the United States.

What is added by this report?

From 2019 to 2020, new HIV diagnoses reported to CDC decreased by 17% accompanied by a considerable decline in HIV testing throughout the identical interval, together with amongst precedence populations in CDC-funded jurisdictions.

What are the implications for public well being apply?

Partnering amongst federal organizations, state, and native well being departments, community-based organizations, and well being care methods to extend entry to companies, together with HIV self-testing and routine opt-out screening in well being care settings, can compensate for testing and diagnoses missed throughout the COVID-19 pandemic and speed up the Ending the HIV Epidemic initiative.

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HIV testing is a core technique for the Ending the HIV Epidemic within the U.S. (EHE) initiative, which has the goal of lowering new HIV infections by a minimum of 90% by 2030.* During 2016–2017, jurisdictions with the very best HIV analysis charges had been these with larger prevalences of HIV testing; past-year HIV testing was larger amongst individuals who reported latest HIV danger behaviors in contrast with those that didn’t report these dangers (1). During 2020–2021, the COVID-19 pandemic disrupted well being care supply, together with HIV testing partly as a result of many individuals prevented companies to adjust to COVID-19 danger mitigation efforts (2). In addition, public well being departments redirected some sexual well being companies to COVID-19–associated actions. CDC analyzed knowledge from 4 nationwide knowledge assortment methods to evaluate the numbers of HIV assessments carried out and HIV infections recognized within the United States within the years earlier than (2019) and through (2020) the COVID-19 pandemic. In 2020, HIV diagnoses reported to CDC decreased by 17% in contrast with these reported in 2019. This lower was preceded by decreases in HIV testing throughout the identical interval, notably amongst precedence populations together with Black or African American (Black) homosexual males, Hispanic or Latino (Hispanic) homosexual males, bisexual males, different males who’ve intercourse with males (MSM), and transgender individuals in CDC-funded jurisdictions. To compensate for testing and diagnoses missed throughout the COVID-19 pandemic and to speed up the EHE initiative, CDC encourages partnerships amongst federal organizations, state and native well being departments, community-based organizations, and well being care methods to extend entry to HIV testing companies, together with methods similar to self-testing and routine opt-out screening in well being care settings.

CDC recommends that every one adolescents and adults aged 13–64 years be examined for HIV a minimum of as soon as, with annual rescreening of individuals who report behaviors that improve the possibilities of buying or transmitting HIV§ (3). Testing is the gateway to preexposure prophylaxis (PrEP) amongst uninfected individuals for whom prophylaxis is indicated and to fast remedy of individuals with HIV an infection (4). The EHE initiative’s emphasis on the position of routine testing contributes to its objectives of lowering HIV infections and reducing HIV disparities amongst populations most affected by the illness. For instance, to forestall new HIV infections, the EHE initiative gives further assets to jurisdictions with populations most disproportionately affected by HIV, together with Black and Hispanic MSM. These populations account for almost all of recent HIV infections within the United States (5).

The COVID-19 pandemic started throughout 2020, when jurisdictions funded to conduct actions as a part of the EHE effort within the United States had been starting to increase testing and different HIV prevention actions. Access to and use of sexually transmitted illness (STD) and HIV diagnostic and preventive companies had been interrupted because the COVID-19 pandemic modified health-seeking behaviors (6). In addition, public well being departments redirected some sexual well being companies to COVID-19–associated actions.

This evaluation summarizes the reported variety of HIV assessments performed and the variety of these check outcomes that had been optimistic throughout 2019–2020. Data on HIV assessments performed had been derived from three overlapping knowledge sources: the Health Resources and Services Administration’s Uniform Data System (HRSA UDS),** CDC’s National HIV Prevention Program Monitoring and Evaluation system (CDC NHM&E),†† and the National Syndromic Surveillance Program’s (NSSP) industrial laboratory knowledge.§§ Data on the variety of optimistic assessments got here from HIV diagnoses reported via the National HIV Surveillance System (NHSS).¶¶ For every knowledge supply, variations between 2019 and 2020 had been calculated for each absolutely the quantity and corresponding percentages of HIV assessments performed. Differences in HIV testing by race and ethnicity and by inhabitants group had been estimated from CDC NHM&E knowledge,*** the one supply of HIV testing knowledge for which these further variables had been obtainable. In addition, the entire variety of HIV antigen or antibody screening assessments had been summarized by the surveillance week††† throughout which they had been carried out to evaluate weekly modifications in testing reported to NSSP from February 3, 2019 (2019, week 6) via December 26, 2020 (2020, week 52). This exercise was reviewed by CDC and was performed per relevant federal regulation and CDC coverage.§§§

During February 3–December 31, 2019, and February 1–December 31, 2020, CDC acquired stories of 17,007,063 complete HIV screening assessments from two industrial laboratories (Table). Analyses of economic laboratory assessments reported by surveillance week indicated that testing volumes remained steady all through 2019, at roughly 200,000 assessments per week (Figure 1). In early 2020, testing volumes exceeded 2019 ranges; nonetheless, by week 12, testing volumes declined to <50% the degrees noticed throughout 2019 and remained low via the top of 2020, with 1,350,609 (14.7%) fewer assessments reported in 2020 in contrast with 2019.

In 2019, HRSA UDS acquired stories of two,713,628 Bureau of Primary Health Care (BPHC)-funded HIV assessments, and CDC NHM&E acquired stories of two,385,343 CDC-funded assessments (together with 1,752,586 [73%] from well being care settings and 632,757 [27%] from non–well being care settings) (Table). These sources reported substantial decreases within the variety of assessments and optimistic ends in 2020 in contrast with 2019. HRSA UDS knowledge indicated an 8.3% lower in HIV screening assessments. In 2020, the entire variety of HIV assessments funded by CDC that had been distributed in well being care and non–well being care settings decreased by practically one half (42.6% and 49.5%, respectively) in contrast with 2019, and ranged from −44.1% to −59.1% for racial and ethnic teams and −47.3% to −57.4% for inhabitants teams (Figure 2) in non–well being care settings throughout this era. Substantial absolute reductions in HIV assessments reported in non–well being care settings had been amongst these prioritized in CDC’s HIV testing efforts, together with 74,947 fewer assessments amongst MSM (a 49.2% discount), 4,145 fewer assessments amongst transgender individuals (a 47.3% discount), and 430,713 (44.1%) and 265,494 (46.3%) fewer assessments amongst Black and Hispanic individuals, respectively. In 2020, 30,635 diagnoses had been reported to NHSS in contrast with 36,940 in 2019 (Table). Reductions in testing had been mirrored by a 17.0% discount in new diagnoses.

Discussion

In 2020, the variety of HIV assessments reported to CDC- and BPHC-funded settings and a few industrial laboratories declined sharply in contrast with 2019. All racial and ethnic teams and inhabitants teams examined skilled substantial decreases in HIV testing, together with populations with elevated potential for HIV acquisition, together with Black and Hispanic individuals, MSM, and transgender individuals, all of whom skilled substantial decreases within the availability of CDC-funded HIV testing. Similar declines in scientific visits for HIV testing and different companies throughout the COVID-19 pandemic (e.g., STD testing and PrEP) have been reported (7).

The COVID-19 pandemic adversely affected efforts to increase HIV testing, together with expansions associated to the EHE initiative. The substantial discount in testing and new diagnoses recommend {that a} concerted effort is required at native, state, and nationwide ranges to extend testing charges amongst all individuals, particularly these populations most affected by HIV, in step with EHE objectives. Self-testing for HIV is one other testing possibility outdoors of well being care settings, and it’s an efficient, handy, and correct approach to diagnose HIV an infection.¶¶¶ Distribution of HIV self-tests will increase consciousness of HIV an infection amongst precedence populations, together with some MSM who don’t report annual HIV testing utilizing different modalities (8). Self-test distribution has expanded since 2020 and might need changed a few of the standard sources of testing within the United States throughout the pandemic (9).

The findings on this report are topic to a minimum of three limitations. First, it can’t be decided whether or not decreases within the variety of reported HIV assessments and new HIV diagnoses resulted from decreased entry to testing companies and laboratory supplies, reductions in sexual behaviors that may make testing pointless, reductions in general HIV incidence, or a mixture of those and different elements. Limited proof obtained via a survey of MSM indicated that sexual exercise declined early within the COVID-19 pandemic (10); related knowledge should not but obtainable for different populations or throughout later phases of the pandemic. Second, CDC NHM&E, HRSA UDS, and industrial laboratory knowledge signify the variety of assessments carried out and never the variety of distinctive individuals examined; purchasers examined a number of instances might need been included within the evaluation. Finally, the findings of this evaluation should not a complete estimate of HIV testing; some testing suppliers, together with some industrial laboratories, don’t report back to NSSP, and self-testing outcomes should not included on this report.

To compensate for testing and diagnoses missed throughout the COVID-19 pandemic and speed up the EHE initiative, partnerships amongst federal organizations, state and native well being departments, community-based organizations, and well being care methods might improve entry to HIV testing companies, together with self-testing. In addition, enlargement of routine screening in well being care settings and domestically tailor-made HIV testing efforts in non–well being care settings is a crucial facet of the EHE initiative and its aim of lowering disparities in HIV diagnoses.**** CDC helps the necessity for status-neutral approaches to well being care and repair supply, which emphasizes ongoing engagement in HIV-related companies no matter an individual’s HIV standing (4).

Acknowledgments

Shaun Chapman, Kirsten Argueta, and Rebecca Levine, Bureau of Primary Health Care, Health Resources and Services Administration.


1Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC.

References

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TABLE. Comparison of HIV testing and analysis knowledge from 4 knowledge sources — United States, 2019 and 2020Return to your place in the text
Characteristic Commercial laboratory testing, NSSP* HRSA UDS, BPHC–funded HIV assessments, well being care settings CDC NHM&E–funded HIV assessments§ NHSS
Health care settings Non–well being care settings
Total HIV-1/HIV-2 ag/ab assessments Reactive assessments Total HIV assessments New diagnoses Total HIV assessments New diagnoses Total HIV assessments New diagnoses HIV diagnoses reported to CDC**
Observed, 2019†† 9,178,836 66,026 2,713,628 7,164 1,752,586 5,374 632,757 3,556 36,940
Observed, 2020†† 7,828,227 55,658 2,489,031 6,304 1,005,553 3,857 319,799 2,509 30,635
Total noticed, 2019–2020 17,007,063 121,684 5,202,659 13,468 2,758,139 9,231 952,556 6,065 67,575
Absolute distinction, 2019–2020 −1,350,609 −10,368 −224,597 −860 −747,033 −1,517 −312,958 −1,047 −6,305
% Change, 2019–2020 −14.7 −15.7 −8.3 −12.0 −42.6 −28.2 −49.5 −29.4 −17.0

Abbreviations: ab = antibody; ag = antigen; BPHC = Bureau of Primary Health Care; HRSA = Health Resources and Services Administration; NHM&E = National HIV Prevention Program Monitoring and Evaluation; NHSS = National HIV Surveillance System; NSSP = National Syndromic Surveillance Program; STD = sexually transmitted illness; TB = tuberculosis.
* NSSP is a collaboration amongst CDC; native and state well being departments; and federal, tutorial, and personal sector companions (https://www.cdc.gov/nssp/index.html). Data had been extracted from two laboratory knowledge sources for all check orders with both an order or consequence containing “56888-1” inside the reported Logical Observation Identifiers Names and Codes, indicative of an HIV-1 or HIV-2 antigen or antibody check really helpful for HIV screening. The efficiency interval throughout which CDC and the laboratories submitted HIV check knowledge started on February 3, 2019.
Number of HIV assessments carried out; the variety of new diagnoses had been extracted from the HRSA Health Center Program Uniform Data System reporting tables. https://data.hrsa.gov/tools/data-reporting/program-data

Return to your place in the textFIGURE 1. Weekly HIV screening assessments* reported by two industrial laboratories — National Syndromic Surveillance Program, United States, February 3, 2019–December 26, 2020§
The figure is a line graph that shows the numbers of weekly HIV screening tests as reported by two commercial laboratories to the National Syndromic Surveillance Program in the United States February 3, 2019–December 26, 2020.

* Data had been extracted from two laboratory knowledge sources for all check orders with both an order or consequence containing “56888-1” inside the reported Logical Observation Identifiers Names and Codes, indicating an HIV-1 or HIV-2 antigen or antibody check really helpful for HIV screening and summed by surveillance week from February 3, 2019 (2019, week 6) via December 26, 2020 (2020, week 52). The efficiency interval throughout which CDC and the laboratories submitted HIV check knowledge started on February 3, 2019.

National Syndromic Surveillance Program is a collaboration amongst CDC; native and state well being departments; and federal, tutorial, and personal sector companions. https://www.cdc.gov/nssp/index.html

§ Data assortment started February 3, 2019.

Return to your place in the textFIGURE 2. Absolute numbers and % change in complete variety of CDC-funded HIV assessments,* by race and ethnicity, and inhabitants group§ in non–well being care settings — United States, 2019 and 2020
The figure is a set of bar graphs that show the absolute numbers and percent change in the total number of CDC-funded HIV tests in non–health care settings by race and ethnicity and by population group in the United States during 2019 and 2020.

Abbreviations: AI/AN = American Indian or Alaska Native; Het. = heterosexual; IDU = injection drug use; MSM = males who’ve intercourse with males; NHM&E = National HIV Prevention Program Monitoring and Evaluation; NH/OPI = Native Hawaiian or different Pacific Islander.

* Summarized from the 2019 (https://www.cdc.gov/hiv/pdf/library/reports/cdc-hiv-annual-HIV-testing-report-2019.pdf

Race and ethnicity classes embrace Hispanic and Latino individuals of any race; a number of races; and American Indian or Alaska Native, Asian, Black, Native Hawaiian or different Pacific Islander, and White races.

§ Population teams are hierarchically assigned based mostly on self-reported behaviors and gender identification. In this determine, the MSM group consists of MSM and MSM who inject medication; the transgender group consists of transgender individuals and transgender individuals who inject medication.

Restricted to non–well being care settings as a result of NHM&E knowledge on inhabitants teams are required for all CDC-funded assessments carried out in non–well being care settings however are solely required for HIV-positive check ends in well being care settings. Non–well being care settings embrace HIV testing websites, neighborhood settings, non–well being care correctional services, well being division discipline visits, and syringe service applications.

Suggested quotation for this text: DiNenno EA, Delaney KP, Pitasi MA, et al. HIV Testing Before and During the COVID-19 Pandemic — United States, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:820–824. DOI: http://dx.doi.org/10.15585/mmwr.mm7125a2


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