Assessing the Impact of COVID-19-Related Distancing and Clinical Service Disruptions on the HIV Epidemic in the United States

PROJECT SUMMARY With over 1.2 million Americans currently living with Human Immunodeficiency Virus (HIV), and nearly 40,000 new infections every year, HIV remains a major public health challenge in the United States. HIV risk is not uniform across the US population: approximately 70% of infections occur among gay, bisexual, and other men who have sex with men (MSM), and certain racial/ethnic groups experience higher HIV risk. HIV transmission remains high despite recent advancements in biomedical prevention and treatment partly because of disparities in access to these measures. Economic and social disruptions from the COVID-19 global pandemic have exacerbated these disparities and created new challenges in HIV control, disrupting access to HIV prevention and clinical care services and prompting major behavioral changes (including reductions in sexual activity, "sexual distancing"). These changes may dramatically impact the trajectory of the US HIV epidemic. There have been reports of decreased HIV diagnoses during the pandemic, but these estimates may be an artifact of reduced screening rather than decreased transmission and are therefore unreliable. Enumerating HIV transmission is critical for the provision of HIV prevention interventions; a better understanding of how the COVID-19 pandemic has affected and will continue to affect HIV dynamics of US MSM is urgently required. Increased transmission due to service disruptions may be offset by sexual distancing, but this depends on the temporal patterns and demographic distribution of these changes. Transmission may also be mitigated by interventions that address clinical disruptions (e.g., telehealth and other home-based HIV medical services). Our overarching hypotheses are: 1) COVID-19-related changes in sexual behavior and service disruptions have varied among US MSM in magnitude and timing by demographic factors, 2) these changes will alter HIV incidence across the pandemic era, and 3) targeted home-based HIV medical care retention interventions can curtail the impact of clinical care disruptions on HIV transmission. In AIM 1, we will triangulate data from two independent longitudinal studies of US MSM to describe the temporal patterns and demographic distribution of sexual distancing and HIV service disruptions. In AIM 2, we will use a network-based HIV transmission model to disentangle changes in HIV transmission versus screening to estimate HIV incidence among US MSM during and after the COVID-19 pandemic. In AIM 3, we will use a transmission model to determine the epidemiologic impact of targeted home-based HIV care retention interventions in a high burden jurisdiction. The findings of this project will both inform HIV surveillance efforts and guide the development of targeted HIV prevention programs. With this research and training program, the applicant will gain a multidisciplinary skill set combining epidemiologic methods, network science, and infectious disease modeling, while advancing our knowledge of HIV dynamics in the COVID era. This unique training will provide the technical skillset needed for the applicant to become a successful independent researcher and infectious disease epidemiologist.