Disruptions of healthcare visits and viral suppression for people living with HIV during the COVID-19 pandemic in the US.

backgroundExisting studies have documented the negative impact of the COVID-19 pandemic on the utilization of health services among people living with HIV (PLWH), including reduced access to medical consultations, antiretroviral therapy (ART) uptake, and viral load monitoring. However, few studies have investigated the pandemic’s effect on clinical outcomes—such as viral suppression rates—particularly within U.S. settings. Using a nationwide data source, this study aims to examine the impact of the COVID-19 pandemic on healthcare visits and viral suppression outcomes of PLWH.

methodsThis retrospective cohort study used data from All of Us (AoU) Research Program, a nationwide cohort designed to be broadly representative of the U.S. population, particularly groups historically underrepresented in biomedical research. Data from more than 340 sites, deposited into AoU and harmonized into a release set spanning January 2018 through December 2021, were used for this study. Using CD4 count or viral load measures as proxies for health care visits, we employed generalized linear mixed regression interrupted time series (ITS) models with a log link to assess the impact of the COVID-19 pandemic on the number of healthcare visits and viral suppressions, comparing data two years before and after the onset of the pandemic. Among 7,667 PLWH identified, 1,772 who had at least one CD4 count or viral load measure were included in the healthcare visit analysis, and 1,382 who had at least one viral load measure were included in the viral suppression analysis.

resultsFor the outcomes of interest, the total number of healthcare visits dropped from 7,902 (average of 4.90 per person) before pandemic to 5,252 (average of 3.70 per person) after the pandemic. Similarly, the total number of viral suppression events declined from 2,361 (average of 1.98 per person) before pandemic to 1,893 (average of 1.88 per person) after pandemic. Compared to the pre-COVID-19 period, the number of healthcare visits among PLWH significantly decreased (adjusted odds ratio [aOR] = 0.80, 95%CI: 0.75–0.86) whereas the number of viral suppression events did not change significantly (aOR = 1.10, 95%CI: 0.97–1.25) after the pandemic. Older individuals had lower odds of healthcare visits, while those with Medicaid insurance and individuals with more comorbidities were more likely to have healthcare visits. Regarding viral suppression, older individuals, Hispanic or Latino participants, and those who were married or living with partners were more likely to achieve viral suppression, whereas individuals with a greater number of comorbidities were less likely to achieve viral suppression.

conclusionsThe COVID-19 pandemic disrupted healthcare visits and contributed to suboptimal viral suppression among underrepresented HIV populations. Targeted interventions are needed to ensure continuous engagement in HIV care during unprecedented health crises.