COVID-19-related excess missed HIV diagnoses in the United States in 2021
Alex Viguerie1, Ruiguang Song1, Anna Satcher Johnson2
1Division of HIV Prevention, Quantitative Sciences Branch.
Insights
In 2021, HIV diagnoses among those infected before 2020 returned to pre-COVID levels. However, the 2020 diagnosis deficit persisted, with fewer diagnoses than expected in some groups, highlighting ongoing COVID-19 impacts.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Surveillance
Background:
- The COVID-19 pandemic caused a significant decline in HIV diagnoses in the US in 2020.
- A previous analysis indicated 18% fewer HIV diagnoses than expected in 2020, suggesting factors beyond transmission decline.
Purpose of the Study:
- To evaluate the progress in closing the 2020 HIV diagnosis deficit in 2021.
- To assess if 2021 HIV diagnosis levels for individuals infected pre-2020 returned to expected pre-COVID trends.
Main Methods:
- Analysis of 2021 HIV diagnosis data from the National HIV Surveillance System.
- Comparison of 2021 diagnosis levels against pre-COVID trends for individuals infected prior to 2020.
- Stratification of results by sex, transmission group, region, and race/ethnicity.
Main Results:
- Overall HIV diagnoses for infections acquired between 2011-2019 returned to pre-COVID levels in 2021.
- Diagnoses among Hispanic/Latino individuals and males reached pre-COVID levels.
- Higher-than-expected diagnoses were observed in White individuals, men who have sex with men (MSM), and those in the South and Northeast, while other groups had fewer diagnoses than expected.
Conclusions:
- The 2020 HIV diagnosis gap remained unclosed by the end of 2021, despite overall recovery to pre-COVID levels.
- Persistent diagnosis deficits in specific populations indicate ongoing COVID-19 disruptions to HIV diagnosis trends in 2021.
- Expanded HIV testing programs are crucial to address these remaining gaps.
Objective:
Coronavirus disease 2019 (COVID-19) and related disruptions led to a significant decline in HIV diagnoses in the United States in 2020. A previous analysis estimated 18% fewer diagnoses than expected among persons with HIV (PWH) acquiring infection in 2019 or earlier, suggesting that the decline in overall diagnoses cannot be attributed solely to decreased transmission. This analysis evaluates the progress made towards closing the 2020 diagnosis deficit in 2021.
Methods:
We apply previously developed methods analyzing 2021 diagnosis data from the National HIV Surveillance System to determine whether 2021 diagnosis levels of PWH infected pre-2020 are above or below the expected pre-COVID trends. Results are stratified by assigned sex at birth, transmission group, geographic region, and race/ethnicity.
Results:
In 2021, HIV diagnoses returned to pre-COVID levels among all PWH acquiring infection 2011-2019. Among Hispanic/Latino PWH and male individuals, diagnoses returned to pre-COVID levels. White PWH, MSM, and PWH living in the south and northeast showed higher-than-expected levels of diagnosis in 2021. For the remaining populations, there were fewer HIV diagnoses in 2021 than expected.
Conclusion:
Although overall diagnoses among persons acquiring HIV pre-2020 returned to pre-COVID levels, the diagnosis gap observed in 2020 remained unclosed at the end of 2021. Fewer than expected diagnoses among certain populations indicate that COVID-19-related disruptions to HIV diagnosis trends remained in 2021. Although some groups showed higher-than-expected levels of diagnoses, such increases were smaller than corresponding 2020 decreases. Expanded testing programs designed to close these gaps are essential.
