The nation’s ability to prevent HIV was “dealt a hard blow” early in the COVID-19 pandemic, according to a new Centers for Disease Control and Prevention (CDC) analysis published on December 1, World AIDS Day. However, according to the CDC, a rapid rebound in services “is a testament to quick, resourceful local innovations that, if scaled up and sustained, could help reach national HIV prevention goals.”

“Today, the world celebrates the dedication, resilience, and creativity of people with HIV and their public health and clinical allies who refused to let a new pandemic stand in the way of ending a longstanding one,” Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said in a press statement. "It is just this type of resolve that, when paired with resources, will enable the nation to weather public health emergencies and prevent HIV at the same time."

According to the report, HIV testing and pre-exposure prophylaxis (PrEP) prescriptions dropped substantially during the early months of the COVID-19 pandemic, as many cities imposed stay-at-home orders and medical services were curtailed or diverted to COVID care. What’s more, many people lost their health insurance due to loss of employment.

CDC researchers analyzed quarterly data from two large U.S. commercial laboratories, the IQVIA Real World Data-Longitudinal Prescription Database and the National HIV Surveillance System.

Nationwide, HIV tests declined about 32% and PrEP prescriptions fell about 6% between the first and second quarters of 2020. HIV testing and PrEP prescriptions started to rebound during the second half of 2020, but they did not reach pre-pandemic levels until early 2021.

Reported HIV diagnoses also fell by 26% nationwide, but this is thought to be a consequence of less testing rather than a real drop in new HIV cases. New York City and San Francisco both reported declines in new HIV cases in 2020—and San Francisco saw a subsequent rise the following year—but experts cautioned that these fluctuations may be due to decreased testing, followed by a catch-up once testing resumed.

Although HIV testing and PrEP prescriptions were disrupted by the pandemic, the provision of HIV treatment remained strong, according to the report. The proportion of people linked to care after an HIV diagnosis, the number prescribed antiretroviral therapy and the proportion who have an undetectable viral load all remained stable.

To maintain access to critical HIV services, communities, clinicians and healthcare systems launched or expanded programs to substitute for tradional in-person care, including telehealth, self-testing and home-delivery of HIV medications and PrEP.

“Investment in local community innovation is vital to strengthening our nation’s HIV prevention and care systems to endure future public health emergencies,” according to the CDC. “Expanding those innovations can also help achieve national goals to end the HIV epidemic.”

Click here to read the full CDC analysis in Morbidity and Mortality Weekly Report.
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