HIV care indicators during the COVID-19 pandemic in relation to pre-pandemic care patterns among people with HIV in North Carolina

TL;DR

The study examines how HIV care in North Carolina changed during the pandemic compared to pre-pandemic patterns.

Contribution

The study identifies distinct pre-pandemic HIV care trajectories and links them to pandemic-era care outcomes.

Findings

Persons with consistently high pre-pandemic care had the highest pandemic HIV lab records.

Low pre-pandemic care groups had minimal pandemic care engagement.

Care patterns before the pandemic predicted outcomes during the pandemic.

Abstract

The COVID-19 pandemic abruptly altered the way HIV care was accessed and delivered. We sought to assess HIV care indicators during the COVID-19 pandemic in relation to pre-pandemic HIV care patterns in North Carolina. Using statewide HIV surveillance data and group-based trajectory models, we identified pre-pandemic HIV care trajectories in two partially overlapping populations: (1) newly HIV-diagnosed from March 2014 through February 2018, followed from diagnosis to pandemic start (March 1, 2020); and (2) previously HIV-diagnosed before March 2016, followed from March 2016 to pandemic start. We analyzed pandemic-period HIV care indicators in both populations. In newly diagnosed persons, pre-pandemic HIV care attendance trajectories comprised “consistently high,” “slowly fluctuating,” “steadily decreasing,” and “low U-shaped” groups. Trajectories in previously diagnosed persons were similar, although two distinct low groups replaced the “low U-shaped” group. In both populations, the “consistently high” groups had the highest predicted percentages of persons, while the “low” care groups had the lowest. HIV care indicators in the first pandemic year corresponded with pre-pandemic care patterns: most persons with high and fluctuating pre-pandemic care had an HIV laboratory record in the pandemic year, while most persons in the low care groups had no record in that year.

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