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CME / ABIM MOC / CE

What Effect Has the COVID-19 Pandemic Had on HIV? 

  • Authors: News Author: Kate Johnson; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 11/18/2022
  • Valid for credit through: 11/18/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

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Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, nurses, nurse practitioners, pharmacists, physician assistants, and other clinicians who treat and manage men in sexual minority groups.

The goal of this activity is for learners to be better able to evaluate the effects of the COVID-19 pandemic on infection outcomes among men in sexual minority groups.

Upon completion of this activity, participants will:

  • Assess trends in preexposure prophylaxis use and HIV infection in the United States
  • Evaluate the effects of the COVID-19 pandemic on infection outcomes among men in sexual minority groups
  • Outline implications for the healthcare team


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News Author

  • Kate Johnson

    Freelance writer, Medscape

    Disclosures

    Kate Johnson has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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CME / ABIM MOC / CE

What Effect Has the COVID-19 Pandemic Had on HIV? 

Authors: News Author: Kate Johnson; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 11/18/2022

Valid for credit through: 11/18/2023

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Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to the approved COVID-19 vaccines are provided in this activity in an effort to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

Preexposure prophylaxis (PrEP) is highly effective in the prevention of HIV infection, but the authors of the current study describe how the uptake of PrEP has been disappointing. In 2015 only 3% of patients eligible for PrEP received a prescription, and this rate improved only to 25% by 2020. PrEP has still been effective in reducing the prevalence of HIV infection, but not all communities have achieved lower rates of HIV. Although White men who have sex with men (MSM) have experienced lower rates of HIV infection in recent years, these rates among Black and Hispanic MSM have increased. Hispanic MSM have the highest increase in the prevalence of HIV infection.

COVID-19 has complicated the prevention of HIV infection. In a study focused on persons of sexual minorities, 1 in 5 people reported increased difficulty in obtaining PrEP prescriptions during the pandemic. This contrasts with the use of treatment for HIV infection, which was demonstrated to remain consistent during the COVID-19 pandemic in 1 study.

The current study evaluates Black and Hispanic men from sexual minority groups to determine whether lack of access to PrEP during the COVID-19 pandemic resulted in a higher number of new HIV infections.

Study Synopsis and Perspective

Changes to HIV PrEP access during the COVID-19 pandemic were linked to higher rates of HIV infection among young sexual minority men and gender-diverse individuals who identified as Black and/or Hispanic/Latino, according to a national survey.

"The public health crisis surrounding COVID-19 had clear impact on PrEP access and risk of HIV acquisition overall," said lead investigator Ethan Morgan, PhD, College of Nursing and the Infectious Disease Institute at The Ohio State University, Columbus.

"This is a stark lesson that when novel public health emergencies arise, extant ones cannot go by the wayside or we risk exacerbating them, such as we see here," he told Medscape Medical News.

The article was published in the October issue of the Journal of Acquired Immune Deficiency Syndromes.

The online survey was administered in 4 waves during the first year and a half of the pandemic, starting in March 2020. Participants were recruited through mailing lists, national networks, community partners, and social media.

Among 796 baseline respondents, 300 agreed to 3 follow-up surveys administered between February and March 2021, between July and August 2021, and between October and November 2021.

Inclusion required participants to identify as Black and/or Hispanic/Latino, be between ages 18 and 29 years, be assigned male at birth, reside in the United States, and have reported anal intercourse with a man in the past 12 months. The researchers noted that given the limited uptake of and adherence to PrEP in the targeted population, they prioritized baseline respondents who reported either current PrEP use or use at least once in their lifetime.

The researchers used separate multivariable logistic regression models to assess the association between odds of testing positive for HIV and other sexually transmitted infections (STIs) across the 4 online study visits and both pandemic-related changes to PrEP access and pandemic-related changes to sexual activity.

Changes in PrEP access were reported by a total of 109 (13.8%) of baseline respondents, and HIV seroconversion was reported in 25 of 292 respondents (8.6%) who reported their HIV and other STI status at follow-up. STI positivity was reported 25.6% of the baseline cohort (n = 204).

Compared with respondents who reported no changes to PrEP access, those who did report change to access were significantly more likely to report HIV seroconversion (adjusted odds ratio [aOR], 2.80; 95% CI, 1.02-7.68). However, Dr Morgan emphasized that the study question did not ask how PrEP had changed, only whether it had.

"While we presume this survey question corresponds to a diminished access to PrEP medication during the COVID-19 pandemic, the question was, 'Has your access to PrEP been impacted by the COVID-19 pandemic?' So, it is unfortunately unclear whether access was diminished or improved," he explained. STI positivity was not associated with PrEP access.

The survey also asked respondents how much the pandemic had affected their sexual activity (measured on a Likert scale of not at all, a little, moderately, quite a bit, and extremely). Respondents reporting greater impact on their sexual activity were more likely to report an STI (aOR, 1.24; 95% CI, 1.10-1.40) during the study period.

In addition, although participants reported a mean of 2.8 sexual partners in the past 3 months, those reporting a greater number were more likely to report an STI (aOR, 1.29; 95% CI, 1.21-1.38).

The researchers suggested that expansion of telehealth and mail-order prescriptions, as well as structural-level interventions addressing pandemic-related unemployment and loss of health insurance, could have helped preserve access to PrEP.

Commenting on the study, Monica Gandhi, MD, MPH, who was not involved in the research, noted that self-reported data can be subject to bias. "However, reduction in services for other medical care has been reported frequently throughout COVID, and so this finding of reduced PrEP access, and subsequent HIV infection, is completely in line with the other studies," she told Medscape Medical News.

Dr Gandhi, who is director of the University of California, San Francisco, Center for AIDS Research and medical director of the HIV/AIDS Clinic ("Ward 86") at San Francisco General Hospital, added: "We knew early on in the COVID-19 pandemic that access to and uptake of PrEP was decreased based on data from Boston's Fenway Institute."

The Boston data, reported July 2020 at the virtual International AIDS Conference, prompted "a real attempt" by clinicians to increase PrEP access and uptake--raising community awareness, dispensing PrEP through mobile units, and changing prescribing patterns--Dr Gandhi said. "We usually see patients every 3 months for PrEP, but with HIV self-testing, we can extend that interval to every 6 months, and we did so in many centers during COVID."

The study was funded by National Institute on Drug Abuse, part of the National Institutes of Health.

Dr Morgan and Dr Gandhi have disclosed no relevant financial relationships.

J Acquir Immune Defic Syndr. Published online October 1, 2022.[1]

Study Highlights

  • Study data were drawn from the PrEP and Substance Use National Survey, an online survey that focuses on Black and Hispanic sexual minority and gender-diverse men. The current research focused on results from 3 waves around the time of the COVID-19 pandemic: March to August 2020, July to August 2021, and October to November 2021.
  • The current study focused on the following survey items:
    • How COVID-19 affected access to PrEP
    • Changes in sexual activity during the pandemic, as measured on a 5-point Likert scale
    • Self-reported new sexually transmitted infections (STIs) and HIV infection
  • The main study analysis focused on whether challenges with access to PrEP was associated with higher risks for incident STI and HIV infection.
  • 796 men completed the survey in the first wave. The mean age of participants was 25.1 years; 77.0% of participants identified as gay, 12.2% identified as bisexual, and 10.7% of participants reported that they had a different sexual orientation; 45.1% of patients had an annual income less than $25,000.
  • 270 participants provided subsequent surveys in waves 2 and 3.
  • 13.8% of participants reported more difficulty obtaining PrEP during the pandemic.
  • The overall change in sexual activity during the pandemic was measured as moderate.
  • 25.6% of patients reported a new STI during follow-up, and 8.6% of the cohort had a new HIV infection.
  • Bisexual men and men identifying as having another sexual orientation were less likely to develop an STI compared with gay men. Other factors associated with a higher risk for STI included changing sexual behavior during the pandemic and a higher number of sexual partners.
  • Age, race, ethnicity, and income were not associated with the risk for STI.
  • PrEP access also did not affect the risk for STI.
  • The adjusted odds ratio for new HIV infection in comparing men with challenges to PrEP access was 2.80 (95% CI, 1.02-7.68). However, changes in sexual activity during the pandemic did not affect the risk for incident HIV infection.

Clinical Implications

  • In 2015 only 3% of patients eligible for PrEP received a prescription; this rate improved only to 25% by 2020. Although White MSM have experienced lower rates of HIV infection in recent years, these rates among Black and Hispanic MSM have increased. Hispanic MSM have the highest increase in the prevalence of HIV infection.
  • The current study finds that the COVID-19 pandemic resulted in difficulty obtaining PrEP among nearly 14% of sexual minority men of color surveyed, and these challenges were associated with a higher risk for incident HIV infection. Although changes in sexual activity during the pandemic were moderate, altering sexual activity was associated with a lower risk for STI and did not affect incident HIV infection.
  • Implications for the healthcare team: With the knowledge that access to appropriate HIV care decreased during the pandemic, the healthcare team should focus on PrEP education and accessibility to as many eligible people as possible.

 

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