CDC’s CROI 2021 Select Studies of Interest

Cross-posted from NCHHSTP Newsroom

CDC scientists will present nearly 30 abstracts at the 2021 Conference on Retroviruses and Opportunistic Infections (CROI). Several studies that may be of particular interest are summarized below and represent two main research areas: COVID-19’s impact on HIV testing and treatment, and disparities among people with HIV.

COVID-19’S IMPACT ON HIV TESTING AND TREATMENT

New CDC research being presented at CROI show alarming drops in the number of people getting HIV tests and accessing HIV care during the COVID-19 pandemic, demonstrating the urgent need for innovative, community-driven solutions to HIV prevention.

Strategies that deliver HIV testing and care in innovative, community-tailored ways will be critical to reversing these declines, including the use or expansion of telemedicine and telehealth, rapid HIV self-tests, mail-in self-tests, and the deployment of higher numbers of community health workers.

CDC is committed to accelerating efforts to end the HIV epidemic in America. CDC funds health departments and local organizations to implement HIV prevention programs and test and diagnose people with HIV, link them to care, and help ensure they stay in care.

This includes supporting Ending the HIV Epidemic: A Plan for America (EHE), the ongoing, multi-year federal initiative aiming to end the HIV epidemic in the United States by 2030. The foundation of EHE are community-driven plans that require the active engagement of people living with, and at risk for, HIV in the design and implementation of local activities that utilize EHE’s four key strategies: Diagnose, Treat, Protect, and Respond. CDC has strongly encouraged these communities to include novel and innovative activities in their plans to meet local needs in a tailored way, especially during COVID-19.

COVID-related studies include:

Impact of COVID-19 on Commercial Laboratory Testing for HIV in the United States

Overview: Researchers used laboratory data from the National Syndromic Surveillance Program to assess the impact of COVID-19 shelter-in-place orders on HIV screening, diagnosis, and viral load monitoring. They found that from March 13 to September 13, 2020, a large commercial laboratory system reported almost 700,000 fewer HIV screening tests and nearly 5,000 fewer confirmed HIV diagnoses compared to the same period in 2019. (Lead Author: Kevin Delaney, CDC)

Impact of COVID-19 on PrEP prescriptions in the United States: a time series analysis

Overview: Using a nationally representative commercial database, researchers analyzed pre-exposure prophylaxis (PrEP) prescriptions and new PrEP users from January 2017 through September 2020 to estimate the impact of COVID-19 on PrEP use in the U.S. A model was used to estimate the expected number of PrEP prescriptions and new PrEP users in the absence of the pandemic. They found that from March 15 to September 30, 2020, the number of PrEP prescriptions in the U.S. dropped by 21 percent, and that there was a 28 percent decrease in new PrEP users during the same time period. (Lead Author: Ya-lin Huang, CDC)

HIV Ambulatory Care during COVID-19 Pandemic in the US: Visits and Viral Load Testing

Overview: Researchers analyzed data from eight HIV outpatient care sites in the U.S. to estimate COVID-19’s impact on outpatient care office visits and viral load testing. They found that from January to June 2020, outpatient office visits for HIV care decreased by 78 percent. (Co-Authors: Jun Li, Kate Buchacz, CDC)

HIV Self-testing and Risk Behaviors among Men who have Sex with Men in 23 US cities

Overview: Researchers assessed over 10,000 responses from the 2017 National HIV Behavioral Surveillance survey to evaluate HIV self-testing usage and its association with preventative behaviors among gay and bisexual men in the U.S.  They found that HIV self-testing was associated with increased HIV testing frequency and had no association with increases in condomless anal sex, STI rates, or new HIV diagnoses. Self-testing is one of many important tools that can help provide access to HIV care amidst COVID-19. (Co-Author: Christine Brune, CDC)

DISPARITIES AMONG PEOPLE WITH HIV

Additional CDC research highlights the persistent regional and racial/ethnic disparities in HIV care and treatment, including the timely receipt of HIV treatment and the association between socioeconomic background and access to care.

The timely initiation of HIV treatment – defined as beginning treatment within 30 days of entering care – is critical to ensuring people stay in care and are able to reach and sustain an undetectable HIV viral load. People who maintain an undetectable viral load live longer, healthier lives and have effectively no risk of sexually transmitting HIV.

Ending the HIV epidemic in the U.S. can only be achieved by eliminating the barriers that prevent equitable access to HIV prevention and care. This includes addressing the root causes and social determinants that have contributed to disparities among certain population groups for far too long, such as poverty, unequal access to health care, lack of education, stigma, systematic racism, and work circumstances.

That is why CDC supports efforts to accelerate progress in reducing disparities among people with HIV. EHE is now working to overcome barriers to HIV prevention and treatment in the 57 areas of the country hardest hit by the epidemic. These areas account for about two-thirds of new infections among African Americans and Hispanics/Latinos, and community plans will include strategies to reduce HIV disparities.

Disparities-related studies include:

Disparities in timely receipt of ART prescription in HIV care in the U.S., 2012–2018

Overview: Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), funded by the National Institutes of Health, researchers studied trends and sociodemographic and clinical disparities in the timely receipt of antiretroviral (ART) treatment prescriptions from 2012–2018. Timely prescription is defined as receipt of treatment prescription within 30 days of entering HIV care. They found that despite overall progress since 2012, African Americans, people with HIV living in the U.S. South, and people with HIV with a history of drug dependence continue to have lower rates of timely ART initiation compared to some other groups. (Lead Author: Jun Li, CDC)

Structural Factors Associated with HIV Care for Black Persons with HIV Diagnosis—United States, 2018

Overview: Researchers used National HIV Surveillance System, U.S. Census, and Home Mortgage Disclosure Act data to identify how HIV care outcomes among African Americans with HIV diagnosed in 2017 were affected by racial mortgage redlining, Medicaid expansion, and Ryan White program use. They found that the majority of African Americans diagnosed with HIV in 2017 resided in areas with high poverty levels and in census tracts where African American mortgage applicants were twice more likely to be rejected for mortgage loans compared to whites. Researchers also found that structural factors that reduced the financial burden of HIV care and improved care access like Medicaid expansion and the Ryan White program improved outcomes such as linkage to HIV care and viral suppression. (Lead Author: Joseph Logan, CDC)